NR603 CEA Prep: Cardiac Questions and Correct Answers
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What is the key long-term benefit of using carvedilol for patients with coronary artery disease
and heart failure with reduced ejection fraction (HFrEF)? - CORRECT ANSWER -Potential
increase in ejection fraction
Rationale: EF increase is a key reason for using carvedilol over metoprolol for patients with low
EF states. Libido unfortunately can be negatively impacted by any beta blocker. Cardiac output
should only improve with long term use, not decrease, and beta blockers may reduce blood
pressure slightly, but that is not their key long-term benefit. In fact, they are not even considered
for routine anti-hypertensive management per JNC-8 guidelines.
A 45-year-old man presents with chest pain radiating to the left arm, diaphoresis, and shortness
of breath. His ECG shows ST-segment elevation. What is the initial management response? -
CORRECT ANSWER -Administer aspirin and call for emergency medical services
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 be likely to decrease the effects of warfarin (Coumadin)? - CORRECT ANSWER -
Broccoli
Rationale: Warfarin (Coumadin) therapy that is a vitamin K antagonist and 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.
As a f/u from a hospitalization an adult patent presents with ankle edema. Which of the following
medications is the most likely cause of the edema? - CORRECT 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.
A nurse practitioner places a 76-year-old patient on nifedipine (Procardia) 10 mg t.i.d. for angina.
The patient is unable to remember to take the medication at the scheduled times. The practitioner
should: - CORRECT ANSWER -Change the dose to extended release 30 mg daily
A geriatric patient is being treated for recurrent deep vein thrombosis with warfarin, 5mg PO
daily. The International Normalized Ratio (INR) is 1.5. The nurse practitioner should: -
CORRECT ANSWER -Increase the dose
Rationale: The target INR for DVT management is 2.0-3.0, so the warfarin dose should be
increased. If the patient has an active clot, they should be bridged with another anticoagulant
when starting warfarin to prevent worsening thrombosis due to initial inhibition of protein C and
S—this is critical, though beyond the scope of this question. Bridging is not needed if starting a
DOAC.
A 60-year-old man with a history of hypertension and diabetes presents with a new-onset
headache and visual disturbances. His blood pressure is 200/110 mmHg. What is the most
appropriate management? - CORRECT ANSWER -Refer to the emergency department
|Already Graded A+||Brand New Version!!!
What is the key long-term benefit of using carvedilol for patients with coronary artery disease
and heart failure with reduced ejection fraction (HFrEF)? - CORRECT ANSWER -Potential
increase in ejection fraction
Rationale: EF increase is a key reason for using carvedilol over metoprolol for patients with low
EF states. Libido unfortunately can be negatively impacted by any beta blocker. Cardiac output
should only improve with long term use, not decrease, and beta blockers may reduce blood
pressure slightly, but that is not their key long-term benefit. In fact, they are not even considered
for routine anti-hypertensive management per JNC-8 guidelines.
A 45-year-old man presents with chest pain radiating to the left arm, diaphoresis, and shortness
of breath. His ECG shows ST-segment elevation. What is the initial management response? -
CORRECT ANSWER -Administer aspirin and call for emergency medical services
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 be likely to decrease the effects of warfarin (Coumadin)? - CORRECT ANSWER -
Broccoli
Rationale: Warfarin (Coumadin) therapy that is a vitamin K antagonist and 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.
As a f/u from a hospitalization an adult patent presents with ankle edema. Which of the following
medications is the most likely cause of the edema? - CORRECT 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.
A nurse practitioner places a 76-year-old patient on nifedipine (Procardia) 10 mg t.i.d. for angina.
The patient is unable to remember to take the medication at the scheduled times. The practitioner
should: - CORRECT ANSWER -Change the dose to extended release 30 mg daily
A geriatric patient is being treated for recurrent deep vein thrombosis with warfarin, 5mg PO
daily. The International Normalized Ratio (INR) is 1.5. The nurse practitioner should: -
CORRECT ANSWER -Increase the dose
Rationale: The target INR for DVT management is 2.0-3.0, so the warfarin dose should be
increased. If the patient has an active clot, they should be bridged with another anticoagulant
when starting warfarin to prevent worsening thrombosis due to initial inhibition of protein C and
S—this is critical, though beyond the scope of this question. Bridging is not needed if starting a
DOAC.
A 60-year-old man with a history of hypertension and diabetes presents with a new-onset
headache and visual disturbances. His blood pressure is 200/110 mmHg. What is the most
appropriate management? - CORRECT ANSWER -Refer to the emergency department
