NURS 5463 (NURS5463) Test |! |! |! |!
4 questions with precise
|! |! |! |!
answers
A 63-year-old man has a 4-minute period of documented expressive aphasia
|! |! |! |! |! |! |! |! |! |! |!
that completely resolved. A workup reveals 70% left internal carotid stenosis
|! |! |! |! |! |! |! |! |! |! |!
and a 50% right internal carotid stenosis. In addition to best medical
|! |! |! |! |! |! |! |! |! |! |! |!
management, which of the following is the most appropriate treatment? - |! |! |! |! |! |! |! |! |! |! |!
Correct answer ✔A. Left CEA |! |! |! |!
An 84-year-old woman has diabetes and congestive heart failure that is
|! |! |! |! |! |! |! |! |! |! |!
refractory to medical treatment. A right carotid bruit is detected on physical
|! |! |! |! |! |! |! |! |! |! |! |!
examination. A duplex study suggests a 50% to 75% right carotid stenosis. |! |! |! |! |! |! |! |! |! |! |! |!
Which of the following is the most appropriate treatment? - Correct answer
|! |! |! |! |! |! |! |! |! |! |! |!
✔A. Medical management |! |!
Which of the following statements regarding carotid artery stenting is most
|! |! |! |! |! |! |! |! |! |! |!
accurate? - Correct answer ✔A. CREST study suggests that older patients
|! |! |! |! |! |! |! |! |! |! |!
have increased combined stroke and death rates in comparison to younger
|! |! |! |! |! |! |! |! |! |! |!
patients
Which of the following does NOT need to be instituted for a patient following
|! |! |! |! |! |! |! |! |! |! |! |! |!
carotid endarterectomy? - Correct answer ✔A. Coumadin to target an INR of
|! |! |! |! |! |! |! |! |! |! |! |! |!
2 to 3
|! |!
,For which of the following patients is a left carotid endarterectomy most
|! |! |! |! |! |! |! |! |! |! |! |!
indicated? - Correct answer ✔A. A 70-year-old man with transient loss of |! |! |! |! |! |! |! |! |! |! |! |!
vision in the left eye that recovered after 20 minutes, and he has 75% left
|! |! |! |! |! |! |! |! |! |! |! |! |! |! |!
carotid stenosis |!
A 73-year-old woman is evaluated in the ED and transferred to the ICU
|! |! |! |! |! |! |! |! |! |! |! |! |!
because of chest pain of 4 hours' duration. Her medical history includes a 20-
|! |! |! |! |! |! |! |! |! |! |! |! |!
year history of hypertension and Type II diabetes mellitus. Her medications
|! |! |! |! |! |! |! |! |! |! |!
include metformin, atenolol, and ASA. On physical examination, her blood
|! |! |! |! |! |! |! |! |! |!
pressure is 130/84 mm Hg, and her heart rate is 87 beats/min and regular.
|! |! |! |! |! |! |! |! |! |! |! |! |! |!
Her jugular vein is distended to 5 cm while the patient is upright. She has a
|! |! |! |! |! |! |! |! |! |! |! |! |! |! |! |!
faint left carotid bruit and bibasilar crackles to one quarter up from the lung
|! |! |! |! |! |! |! |! |! |! |! |! |! |!
bases. A normal S1 and S2 is heard, with a grade II/VI holosystolic murmur
|! |! |! |! |! |! |! |! |! |! |! |! |! |!
heard best at the apex to the axilla. An electrocardiogram from six months
|! |! |! |! |! |! |! |! |! |! |! |! |!
ago was normal. The ECG was seen during the chest pain. The initial serum
|! |! |! |! |! |! |! |! |! |! |! |! |! |!
troponin measurement is elevated. She is now admitted to the ICU for an MI.
|! |! |! |! |! |! |! |! |! |! |! |! |!
She is free of chest pain while on IV nitroglycerin, and her vital signs are
|! |! |! |! |! |! |! |! |! |! |! |! |! |! |! |!
stable. Which of the fol - Correct answer ✔A. Left bundle branch block with
|! |! |! |! |! |! |! |! |! |! |! |! |! |!
normal sinus rhythm |! |!
A 55-year-old man in the ICU has ACS, with 2 mm of ST elevation on the
|! |! |! |! |! |! |! |! |! |! |! |! |! |! |! |!
leads II, III, and aVF. The troponins are positive. The blood pressure is
|! |! |! |! |! |! |! |! |! |! |! |! |!
130/70 mm Hg on |! |! |!
a nitroglycerin drip at 5 μg/kg/min keeping the patient chest pain free, but
|! |! |! |! |! |! |! |! |! |! |! |! |!
ECG changes persist and only 1 mm of ST elevation is seen. There is no
|! |! |! |! |! |! |! |! |! |! |! |! |! |! |!
lower extremity edema. The patient was given ASA upon entry into the ED.
|! |! |! |! |! |! |! |! |! |! |! |! |!
What is/are the next best steps in the management of this patient? - Correct
|! |! |! |! |! |! |! |! |! |! |! |! |! |!
answer ✔Anticoagulation, IV β-blocker, ACE inhibitor, nitroglycerin, and
|! |! |! |! |! |! |! |!
alert catheterization lab |! |!
, A 65-year-old man with history of diabetes presents to the Emergency
|! |! |! |! |! |! |! |! |! |! |!
Department stating he has had substernal chest pain and diaphoresis for 45
|! |! |! |! |! |! |! |! |! |! |! |!
minutes. Which is the most important next step in management? - Correct
|! |! |! |! |! |! |! |! |! |! |! |!
answer ✔Aspirin to chew |! |! |!
In the initial evaluation of a patient with chest pain, which is the most
|! |! |! |! |! |! |! |! |! |! |! |! |! |!
important diagnostic test? - Correct answer ✔ECG |! |! |! |! |! |!
A 54-year-old man is seen at a rural ED with 1 hour of nausea and substernal
|! |! |! |! |! |! |! |! |! |! |! |! |! |! |!
chest pain radiating to his jaw. The ECG shows STEMI. PCI is not performed
|! |! |! |! |! |! |! |! |! |! |! |! |! |!
at this hospital and only performed at a hospital 2 1/2 hours away. Which of
|! |! |! |! |! |! |! |! |! |! |! |! |! |! |! |!
the following statements is most accurate? - Correct answer ✔C Administer
|! |! |! |! |! |! |! |! |! |! |!
thrombolytics, then transfer to PCI center. |! |! |! |! |!
Which of the following is NOT an accurate description of hypothermia
|! |! |! |! |! |! |! |! |! |! |!
therapy for post-cardiac arrest patients? - Correct answer ✔B Therapeutic
|! |! |! |! |! |! |! |! |! |!
hypothermia has a proven effect in reducing the rate of recurrent ventricular
|! |! |! |! |! |! |! |! |! |! |! |!
fibrillation
A 64-year-old man who was being treated in the hospital for acute
|! |! |! |! |! |! |! |! |! |! |! |!
cholecystitis is found to be unresponsive. He was noted to be in VF and
|! |! |! |! |! |! |! |! |! |! |! |! |! |!
underwent chest compressions for several minutes in addition to
|! |! |! |! |! |! |! |! |!
cardioversion. The patient has return of spontaneous rhythm and vital signs. |! |! |! |! |! |! |! |! |! |! |!
Which of the following is an important treatment for this patient? - Correct
|! |! |! |! |! |! |! |! |! |! |! |! |!
answer ✔A Percutaneous coronary angiography
|! |! |! |!
4 questions with precise
|! |! |! |!
answers
A 63-year-old man has a 4-minute period of documented expressive aphasia
|! |! |! |! |! |! |! |! |! |! |!
that completely resolved. A workup reveals 70% left internal carotid stenosis
|! |! |! |! |! |! |! |! |! |! |!
and a 50% right internal carotid stenosis. In addition to best medical
|! |! |! |! |! |! |! |! |! |! |! |!
management, which of the following is the most appropriate treatment? - |! |! |! |! |! |! |! |! |! |! |!
Correct answer ✔A. Left CEA |! |! |! |!
An 84-year-old woman has diabetes and congestive heart failure that is
|! |! |! |! |! |! |! |! |! |! |!
refractory to medical treatment. A right carotid bruit is detected on physical
|! |! |! |! |! |! |! |! |! |! |! |!
examination. A duplex study suggests a 50% to 75% right carotid stenosis. |! |! |! |! |! |! |! |! |! |! |! |!
Which of the following is the most appropriate treatment? - Correct answer
|! |! |! |! |! |! |! |! |! |! |! |!
✔A. Medical management |! |!
Which of the following statements regarding carotid artery stenting is most
|! |! |! |! |! |! |! |! |! |! |!
accurate? - Correct answer ✔A. CREST study suggests that older patients
|! |! |! |! |! |! |! |! |! |! |!
have increased combined stroke and death rates in comparison to younger
|! |! |! |! |! |! |! |! |! |! |!
patients
Which of the following does NOT need to be instituted for a patient following
|! |! |! |! |! |! |! |! |! |! |! |! |!
carotid endarterectomy? - Correct answer ✔A. Coumadin to target an INR of
|! |! |! |! |! |! |! |! |! |! |! |! |!
2 to 3
|! |!
,For which of the following patients is a left carotid endarterectomy most
|! |! |! |! |! |! |! |! |! |! |! |!
indicated? - Correct answer ✔A. A 70-year-old man with transient loss of |! |! |! |! |! |! |! |! |! |! |! |!
vision in the left eye that recovered after 20 minutes, and he has 75% left
|! |! |! |! |! |! |! |! |! |! |! |! |! |! |!
carotid stenosis |!
A 73-year-old woman is evaluated in the ED and transferred to the ICU
|! |! |! |! |! |! |! |! |! |! |! |! |!
because of chest pain of 4 hours' duration. Her medical history includes a 20-
|! |! |! |! |! |! |! |! |! |! |! |! |!
year history of hypertension and Type II diabetes mellitus. Her medications
|! |! |! |! |! |! |! |! |! |! |!
include metformin, atenolol, and ASA. On physical examination, her blood
|! |! |! |! |! |! |! |! |! |!
pressure is 130/84 mm Hg, and her heart rate is 87 beats/min and regular.
|! |! |! |! |! |! |! |! |! |! |! |! |! |!
Her jugular vein is distended to 5 cm while the patient is upright. She has a
|! |! |! |! |! |! |! |! |! |! |! |! |! |! |! |!
faint left carotid bruit and bibasilar crackles to one quarter up from the lung
|! |! |! |! |! |! |! |! |! |! |! |! |! |!
bases. A normal S1 and S2 is heard, with a grade II/VI holosystolic murmur
|! |! |! |! |! |! |! |! |! |! |! |! |! |!
heard best at the apex to the axilla. An electrocardiogram from six months
|! |! |! |! |! |! |! |! |! |! |! |! |!
ago was normal. The ECG was seen during the chest pain. The initial serum
|! |! |! |! |! |! |! |! |! |! |! |! |! |!
troponin measurement is elevated. She is now admitted to the ICU for an MI.
|! |! |! |! |! |! |! |! |! |! |! |! |!
She is free of chest pain while on IV nitroglycerin, and her vital signs are
|! |! |! |! |! |! |! |! |! |! |! |! |! |! |! |!
stable. Which of the fol - Correct answer ✔A. Left bundle branch block with
|! |! |! |! |! |! |! |! |! |! |! |! |! |!
normal sinus rhythm |! |!
A 55-year-old man in the ICU has ACS, with 2 mm of ST elevation on the
|! |! |! |! |! |! |! |! |! |! |! |! |! |! |! |!
leads II, III, and aVF. The troponins are positive. The blood pressure is
|! |! |! |! |! |! |! |! |! |! |! |! |!
130/70 mm Hg on |! |! |!
a nitroglycerin drip at 5 μg/kg/min keeping the patient chest pain free, but
|! |! |! |! |! |! |! |! |! |! |! |! |!
ECG changes persist and only 1 mm of ST elevation is seen. There is no
|! |! |! |! |! |! |! |! |! |! |! |! |! |! |!
lower extremity edema. The patient was given ASA upon entry into the ED.
|! |! |! |! |! |! |! |! |! |! |! |! |!
What is/are the next best steps in the management of this patient? - Correct
|! |! |! |! |! |! |! |! |! |! |! |! |! |!
answer ✔Anticoagulation, IV β-blocker, ACE inhibitor, nitroglycerin, and
|! |! |! |! |! |! |! |!
alert catheterization lab |! |!
, A 65-year-old man with history of diabetes presents to the Emergency
|! |! |! |! |! |! |! |! |! |! |!
Department stating he has had substernal chest pain and diaphoresis for 45
|! |! |! |! |! |! |! |! |! |! |! |!
minutes. Which is the most important next step in management? - Correct
|! |! |! |! |! |! |! |! |! |! |! |!
answer ✔Aspirin to chew |! |! |!
In the initial evaluation of a patient with chest pain, which is the most
|! |! |! |! |! |! |! |! |! |! |! |! |! |!
important diagnostic test? - Correct answer ✔ECG |! |! |! |! |! |!
A 54-year-old man is seen at a rural ED with 1 hour of nausea and substernal
|! |! |! |! |! |! |! |! |! |! |! |! |! |! |!
chest pain radiating to his jaw. The ECG shows STEMI. PCI is not performed
|! |! |! |! |! |! |! |! |! |! |! |! |! |!
at this hospital and only performed at a hospital 2 1/2 hours away. Which of
|! |! |! |! |! |! |! |! |! |! |! |! |! |! |! |!
the following statements is most accurate? - Correct answer ✔C Administer
|! |! |! |! |! |! |! |! |! |! |!
thrombolytics, then transfer to PCI center. |! |! |! |! |!
Which of the following is NOT an accurate description of hypothermia
|! |! |! |! |! |! |! |! |! |! |!
therapy for post-cardiac arrest patients? - Correct answer ✔B Therapeutic
|! |! |! |! |! |! |! |! |! |!
hypothermia has a proven effect in reducing the rate of recurrent ventricular
|! |! |! |! |! |! |! |! |! |! |! |!
fibrillation
A 64-year-old man who was being treated in the hospital for acute
|! |! |! |! |! |! |! |! |! |! |! |!
cholecystitis is found to be unresponsive. He was noted to be in VF and
|! |! |! |! |! |! |! |! |! |! |! |! |! |!
underwent chest compressions for several minutes in addition to
|! |! |! |! |! |! |! |! |!
cardioversion. The patient has return of spontaneous rhythm and vital signs. |! |! |! |! |! |! |! |! |! |! |!
Which of the following is an important treatment for this patient? - Correct
|! |! |! |! |! |! |! |! |! |! |! |! |!
answer ✔A Percutaneous coronary angiography
|! |! |! |!
