Science Medicine Cardiology
CEA Week 1 Exam
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Cardiology: Treatments for Angina a... 28. Disorders of Cardiac Conduction... Chapter 3.5: The heart and its syste... Erdelja
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2.0-3.0
The suggested International Normalized
Ratio (INR) range in a patient being treated Rationale
for atrial fibrillation is: 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
1.0-2.0 of 2.0, think of the patient as twice as thin for their blood as their normal. Protime can
4.0-5.0 also be used to evaluate bleeding time for warfarin patients, but has in general been
2.0-3.0 replaced many years ago by the INR as the standard measurement, where PTT
3.0-4.0 (partial thromboplastin time) or Anti-Xa are more useful for evaluating bleeding times
related to Heparin therapy.
Avoidance of cold
Nonpharmacologic therapy for Raynaud's
disease include: Rationale
Raynaud's disease is a peripheral vascular syndrome triggered by cold exposure
Use of hot soaks which causes the patient to have extremely pale/white vasoconstricted digits
Avoidance of cold followed by a over-dilated vasoplegic response causing purplish painful
Isometric exercise revascularization. Avoidance of cold is the most effective non-pharmacologic way to
Ginkgo biloba mitigate this event from occurring. Pharmacologic therapy would include the use of
medications such as calcium channel blockers.
At a follow up from a hospitalization, an Norvasc
adult patient presents with ankle edema.
Which of the following medications is the Rationale
most likely cause of the edema? The most common side effects of calcium channel blockers include constipation and
lower extremity edema. The other options do not have any relationship specifically
Metformin with edema, in fact, hydrochlorothiazide specifically reduces edema via diuresis.
HCTZ
Norvasc
Nebivolol
, 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
An adult patient must maintain an
notorious for increasing vitamin K levels, and therefore inhibiting the anticoagulation
International Normalized Ratio (INR)
effect of warfarin. It's also important to remember that with the direct oral
between 2.0 and 3.0. The patient goes to a
anticoagulants category, vitamin K is not affected, and therefore no dietary
clinic for INR determination, and the result
restrictions are required for this class of medications such as apixaban, rivaroxaban,
is 1.4. Which of the following would likely
and edoxaban, which is a distinct benefit over warfarin as noted above. Also, with
decrease the effects of warfarin
warfarin it is important to remember that the effects are based on the free drug, not
(Coumadin)?
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
Red meat
chronically.
Grapefruit
Red Wine
With respect to this particular question, red wine and grapefruit do not have an
Broccoli
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.
A 50-year-old woman with a history of Congestive Heart Failure
hypertension presents with dyspnea on
exertion and orthopnea. On examination, Rationale
she has jugular venous distention and Of the available options, the most accurate response is congestive heart failure as it
bilateral crackles on lung auscultation. is signifying both a right ventricular back up with jugular venous extension and
What is the most likely diagnosis? 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,
Congestive heart failure however, a patient has not described that, rather is only describing dyspnea on
Pulmonary embolism exertion and orthopnea, which both speak to a state of fluid overload. The only
Acute myocardial infarction appropriate response of these available is congestive heart failure.
Chronic obstructive pulmonary disease
An older adult female presents for her Physical activity for 30 minutes daily, for a minimum of 5 days a week
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
, A 75-year-old patient has just been Furosemide (Lasix), lisinopril (Zestril), carvedilol (Coreg)
discharged to a nursing facility following
hospitalization for an exacerbation of Rationale
chronic heart failure. The patient's condition Goal directed therapy for reducing chronic symptoms of heart failure, and hopefully
is classified as stage C, which involves improving ejection fraction in a patient with heart failure with reduced ejection
known structural heart disease with fraction should include carvedilol (Coreg) furosemide (Lasix) or another loop
previous or present symptoms of failure. If diuretic, and an ACE inhibitor/ARB or ARB/ARNI such as sacubitril/valsartan
the patient is adherent to current clinical (Entresto). Calcium channel blockers are contraindicated and heart failure such as
guidelines, the nurse practitioner who is amlodipine (Norvasc).
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)
Your patient presents with bradycardia, Inferior Wall
severe nausea, and substernal pain. STEMI
was identified on the EKG. Which region of Rationale
the heart is most likely involved? 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
Lateral Wall nodes in most patients. Dyspepsia is common in RCA territory injury due to vagal
Anterior Wall stimulation not typical of other areas.
Inferior Wall
Septal Wall
What is the key long-term benefit of using Potential increase in ejection fraction
carvedilol for patients with coronary artery
disease and heart failure with reduced Rationale
ejection fraction (HFrEF)? 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.
Increase in libido Cardiac output should only improve with long term use, not decrease, and beta
Reduction in cardiac output blockers may reduce blood pressure slightly, but that is not their key long-term
Baseline reduction of blood pressure benefit. In fact, they are not even considered for routine anti-hypertensive
Potential increase in ejection fraction management per JNC-8 guidelines.
Your patient presents with pale, waxy legs, Ankle Brachial Index (ABI)
weak peripheral pulses, and states he is
having difficulty walking great distances Rationale
due to the pain in his calves. The most ABI is the most effective way to evaluate vascular flow in a non-invasive way, and the
appropriate non-invasive test to evaluate angiogram of the leg with runoff is the best invasive way. Bilateral popliteal blood
his leg vascular flow quality is which of the pressures would not show discretion between upper and lower body if both equally
following exams? low, and exercise stress tests are not used as a diagnostic tool for claudication or
PAD.
Exercise stress test
Angiogram of the leg with runoff
Ankle Brachial Index (ABI)
Bilateral popliteal blood pressures
CEA Week 1 Exam
Save
Students also studied
Cardiology: Treatments for Angina a... 28. Disorders of Cardiac Conduction... Chapter 3.5: The heart and its syste... Erdelja
39 terms 40 terms 17 terms 22 terms
TKA_papro Preview timothy_tinay Preview alexisfiero2006 Preview Che
2.0-3.0
The suggested International Normalized
Ratio (INR) range in a patient being treated Rationale
for atrial fibrillation is: 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
1.0-2.0 of 2.0, think of the patient as twice as thin for their blood as their normal. Protime can
4.0-5.0 also be used to evaluate bleeding time for warfarin patients, but has in general been
2.0-3.0 replaced many years ago by the INR as the standard measurement, where PTT
3.0-4.0 (partial thromboplastin time) or Anti-Xa are more useful for evaluating bleeding times
related to Heparin therapy.
Avoidance of cold
Nonpharmacologic therapy for Raynaud's
disease include: Rationale
Raynaud's disease is a peripheral vascular syndrome triggered by cold exposure
Use of hot soaks which causes the patient to have extremely pale/white vasoconstricted digits
Avoidance of cold followed by a over-dilated vasoplegic response causing purplish painful
Isometric exercise revascularization. Avoidance of cold is the most effective non-pharmacologic way to
Ginkgo biloba mitigate this event from occurring. Pharmacologic therapy would include the use of
medications such as calcium channel blockers.
At a follow up from a hospitalization, an Norvasc
adult patient presents with ankle edema.
Which of the following medications is the Rationale
most likely cause of the edema? The most common side effects of calcium channel blockers include constipation and
lower extremity edema. The other options do not have any relationship specifically
Metformin with edema, in fact, hydrochlorothiazide specifically reduces edema via diuresis.
HCTZ
Norvasc
Nebivolol
, 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
An adult patient must maintain an
notorious for increasing vitamin K levels, and therefore inhibiting the anticoagulation
International Normalized Ratio (INR)
effect of warfarin. It's also important to remember that with the direct oral
between 2.0 and 3.0. The patient goes to a
anticoagulants category, vitamin K is not affected, and therefore no dietary
clinic for INR determination, and the result
restrictions are required for this class of medications such as apixaban, rivaroxaban,
is 1.4. Which of the following would likely
and edoxaban, which is a distinct benefit over warfarin as noted above. Also, with
decrease the effects of warfarin
warfarin it is important to remember that the effects are based on the free drug, not
(Coumadin)?
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
Red meat
chronically.
Grapefruit
Red Wine
With respect to this particular question, red wine and grapefruit do not have an
Broccoli
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.
A 50-year-old woman with a history of Congestive Heart Failure
hypertension presents with dyspnea on
exertion and orthopnea. On examination, Rationale
she has jugular venous distention and Of the available options, the most accurate response is congestive heart failure as it
bilateral crackles on lung auscultation. is signifying both a right ventricular back up with jugular venous extension and
What is the most likely diagnosis? 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,
Congestive heart failure however, a patient has not described that, rather is only describing dyspnea on
Pulmonary embolism exertion and orthopnea, which both speak to a state of fluid overload. The only
Acute myocardial infarction appropriate response of these available is congestive heart failure.
Chronic obstructive pulmonary disease
An older adult female presents for her Physical activity for 30 minutes daily, for a minimum of 5 days a week
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
, A 75-year-old patient has just been Furosemide (Lasix), lisinopril (Zestril), carvedilol (Coreg)
discharged to a nursing facility following
hospitalization for an exacerbation of Rationale
chronic heart failure. The patient's condition Goal directed therapy for reducing chronic symptoms of heart failure, and hopefully
is classified as stage C, which involves improving ejection fraction in a patient with heart failure with reduced ejection
known structural heart disease with fraction should include carvedilol (Coreg) furosemide (Lasix) or another loop
previous or present symptoms of failure. If diuretic, and an ACE inhibitor/ARB or ARB/ARNI such as sacubitril/valsartan
the patient is adherent to current clinical (Entresto). Calcium channel blockers are contraindicated and heart failure such as
guidelines, the nurse practitioner who is amlodipine (Norvasc).
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)
Your patient presents with bradycardia, Inferior Wall
severe nausea, and substernal pain. STEMI
was identified on the EKG. Which region of Rationale
the heart is most likely involved? 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
Lateral Wall nodes in most patients. Dyspepsia is common in RCA territory injury due to vagal
Anterior Wall stimulation not typical of other areas.
Inferior Wall
Septal Wall
What is the key long-term benefit of using Potential increase in ejection fraction
carvedilol for patients with coronary artery
disease and heart failure with reduced Rationale
ejection fraction (HFrEF)? 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.
Increase in libido Cardiac output should only improve with long term use, not decrease, and beta
Reduction in cardiac output blockers may reduce blood pressure slightly, but that is not their key long-term
Baseline reduction of blood pressure benefit. In fact, they are not even considered for routine anti-hypertensive
Potential increase in ejection fraction management per JNC-8 guidelines.
Your patient presents with pale, waxy legs, Ankle Brachial Index (ABI)
weak peripheral pulses, and states he is
having difficulty walking great distances Rationale
due to the pain in his calves. The most ABI is the most effective way to evaluate vascular flow in a non-invasive way, and the
appropriate non-invasive test to evaluate angiogram of the leg with runoff is the best invasive way. Bilateral popliteal blood
his leg vascular flow quality is which of the pressures would not show discretion between upper and lower body if both equally
following exams? low, and exercise stress tests are not used as a diagnostic tool for claudication or
PAD.
Exercise stress test
Angiogram of the leg with runoff
Ankle Brachial Index (ABI)
Bilateral popliteal blood pressures
