NR 603 CEA practice Quiz and Answers with
Verified Answers and Rationales Latest Update
Graded A+
QUESTIONS AND ANSWERS
Your patient has been diagnosed with a 4.5cm ascending aortic aneurysm. Which medical
imaging is considered standard of care for serial surveillance?
CT PE rule-out protocol
Transesophageal Echocardiogram
Plain film chest X-ray (CXR)
CT angiography of the chest. ANSWER - CT angiography of the chest
Rationale: CT angiography is considered the standard of care for measuring vascular
luminal dimensions with contrast. CT PE protocol is not timed properly for the aorta (it's
timed for the pulmonary artery). Although a plain film is able to catch large aneurysms at
times, they are not able to provide multi-axis reconstruction needed to accurately measure
the size. Transesophageal echo is not needed to accurately measure the aorta and requires
the patient to undergo sedation which is unnecessary.
Which of the following end-organ sequelae is not directly caused by uncontrolled
hypertension?
Hemorrhagic stroke
Proteinuria
Peripheral neuropathy
AV nicking. ANSWER - Peripheral neuropathy
Rationale: Although patients with hypertension frequently have peripheral neuropathy, it is
only directly attributed to patients who are also diabetic and is commonly found in non-
hypertensive diabetic patients. Proteinuria, AV nicking, and hemorrhagic stroke are all
caused by uncontrolled hypertension.
Which of the following medical exam requires the patient to be sedated?
Tilt table test
Transesophageal echocardiogram (TEE)
,Nuclear stress test
Transthoracic echocardiogram (TTE). ANSWER - TEE
Rationale: Due to the invasive nature of the TEE, patients will require procedural sedation.
The patient undergoing a transthoracic echo, tilt table, and nuclear stress test are all fully
alert during these procedures.
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:
increase the dosage to 20 mg b.i.d.
discontinue the issue with the patient's daughter.
change the dose to extended release 30 mg daily.
reinforce the importance of taking the medication.. ANSWER - change the dose to
extended release 30 mg daily
An 80-year-old man with a history of atrial fibrillation presents with sudden-onset
unilateral leg pain and pallor. What is the most likely diagnosis?
Acute arterial occlusion
Deep vein thrombosis
Peripheral artery disease
Cellulitis. ANSWER - Acute arterial occlusion
The most important diagnostic factor in evaluating angina pectoris is the patient's:
Physical examination
Echocardiogram
Cardiac MRI
History. ANSWER - History
Rationale: When it comes to cardiac patients, it's important to remember that history is the
most important diagnostic factor in evaluating angina pectoris. A patient's history can
easily make the diagnosis by simply providing a history of their precipitating factors and
symptoms, such as exertional dyspnea, Reproducible, cardiac stressors such as exercise,
strenuous activity, and the associated symptoms. Cardiac MRI may evaluate the patient's
heart with find detail, but it does not show active ischemia well, rather evidence of old MI
and ventricular wall thinning. Physical examination likewise is not very particular to
cardiac patients and their cardiac disease state, and although there may be some associated
signs, they are not specific. Echocardiogram is also useful tool to evaluate ejection fraction
and valve/wall function, but this is not showcase ischemia well.
,Your patient is complaining of paroxysmal atrial fibrillation. Which medical procedure is
commonly used to treat this condition?
Cryoablation of the transition zone of the left pulmonary vein inflow to the left atrium
Placement of biventricular pacing
Radio frequency ablation of the left ventricular apex
Overdrive pacing via an epicardial lead. ANSWER - Cryoablation of the transition zone of
the left pulmonary vein inflow to the left atrium
Rationale: The transition zone of pulmonary vein to left atrium represents the most
common source of atrial fibrillation and is commonly treated with scarification, radio
frequency ablation, or cryotherapy to impede the electrical stimulation of a-fib to the rest of
the atrium.
Wrong answerQuestion pts
Your patient with a history of two coronary stents and a LDL of 190 has been started on
lipid-lowering statin therapy on three separate attempts with considerable side effects such
as leg pain and in one event, hospitalization for rhabdomyolysis. Which is the best option
moving forward to manage their lipids?
Initiate PCSK9 Inhibitor therapy
Use ezetimibe as monotherapy
Reattempt statin therapy
Aspiring 81mg daily. ANSWER - Initiate PCSK9 Inhibitor therapy
Rationale: Aspirin is not considered a lipid lowering agent. History of statin-induced
rhabdomyolysis is a contraindication for further statin attempts. Ezetimibe as monotherapy
does not provide any appreciable decrease in LDL to goal of <100 for proven CAD (patient
has stents in place). PCSK9 Inhibitors are the best available drug class for this patient.
Wrong answerQuestion pts
Which of the following medications does not cause beta 1 stimulation?
dobutamine
phenylephrine
epinephrine
dopamine. ANSWER - Phenylepherine
Rationale: Phenylephrine only stimulates alpha 1 receptors. The remaining three all have
beta receptor activity.
, The suggested International Normalized Ratio (INR) range in a patient being treated for
atrial fibrillation is:
1.0-2.0
3.0-4.0
2.0-3.0
4.0-5.0. ANSWER - 2.0-3.0
Rationale: 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 of 2.0,
think of the patient as twice as thin for their blood as their normal. Protime can also be used
to evaluate bleeding time for warfarin patients, but has in general been replaced many years
ago by the INR as the standard measurement, where PTT (partial thromboplastin time) or
Anti-Xa are more useful for evaluating bleeding times related to Heparin therapy.
A 35-year-old woman with a history of hypothyroidism presents with fatigue, weight gain,
constipation, and cold intolerance. Her TSH level is elevated, and her free T4 is low. What
is the most appropriate next step in management?
Increase levothyroxine dosage
Order an antithyroperoxidase antibody test
Refer to an endocrinologist
Start methimazole. ANSWER - Increase levothyroxine dosage
Rationale: Her clinical findings suggest she has not found a stable state (euthyroid) of her
thyroid supplementation and an increased dose should be given to reduce her cinical
findings of hypothyroidism. This is supported by her TSH being elevated and the T4 being
low, both which support the patient not having enough thryoid to bring the TSH down to
normal and the T3/T4 up to normal.
An adult male who has managed type 2 diabetes mellitus well for many years presents for a
6-month follow up. His Hgb A1c has risen from 7% to 9% over the interval. All other
laboratory values are normal and his BMI is still 25. His psychiatrist recently added
olanzapine (Zypreza) to the medical regimen. The nurse practitioner will most likely:
Encourage the patient to start walking for 30 min every other day
Begin to increase the patient's diabetes medications incrementally
Encourage the patient to cut back on dietary intake
Discontinue the olanzapine until the patient's psychiatrist has been consulted. ANSWER -
Begin to increase the patient's diabetes medications incrementally
Verified Answers and Rationales Latest Update
Graded A+
QUESTIONS AND ANSWERS
Your patient has been diagnosed with a 4.5cm ascending aortic aneurysm. Which medical
imaging is considered standard of care for serial surveillance?
CT PE rule-out protocol
Transesophageal Echocardiogram
Plain film chest X-ray (CXR)
CT angiography of the chest. ANSWER - CT angiography of the chest
Rationale: CT angiography is considered the standard of care for measuring vascular
luminal dimensions with contrast. CT PE protocol is not timed properly for the aorta (it's
timed for the pulmonary artery). Although a plain film is able to catch large aneurysms at
times, they are not able to provide multi-axis reconstruction needed to accurately measure
the size. Transesophageal echo is not needed to accurately measure the aorta and requires
the patient to undergo sedation which is unnecessary.
Which of the following end-organ sequelae is not directly caused by uncontrolled
hypertension?
Hemorrhagic stroke
Proteinuria
Peripheral neuropathy
AV nicking. ANSWER - Peripheral neuropathy
Rationale: Although patients with hypertension frequently have peripheral neuropathy, it is
only directly attributed to patients who are also diabetic and is commonly found in non-
hypertensive diabetic patients. Proteinuria, AV nicking, and hemorrhagic stroke are all
caused by uncontrolled hypertension.
Which of the following medical exam requires the patient to be sedated?
Tilt table test
Transesophageal echocardiogram (TEE)
,Nuclear stress test
Transthoracic echocardiogram (TTE). ANSWER - TEE
Rationale: Due to the invasive nature of the TEE, patients will require procedural sedation.
The patient undergoing a transthoracic echo, tilt table, and nuclear stress test are all fully
alert during these procedures.
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:
increase the dosage to 20 mg b.i.d.
discontinue the issue with the patient's daughter.
change the dose to extended release 30 mg daily.
reinforce the importance of taking the medication.. ANSWER - change the dose to
extended release 30 mg daily
An 80-year-old man with a history of atrial fibrillation presents with sudden-onset
unilateral leg pain and pallor. What is the most likely diagnosis?
Acute arterial occlusion
Deep vein thrombosis
Peripheral artery disease
Cellulitis. ANSWER - Acute arterial occlusion
The most important diagnostic factor in evaluating angina pectoris is the patient's:
Physical examination
Echocardiogram
Cardiac MRI
History. ANSWER - History
Rationale: When it comes to cardiac patients, it's important to remember that history is the
most important diagnostic factor in evaluating angina pectoris. A patient's history can
easily make the diagnosis by simply providing a history of their precipitating factors and
symptoms, such as exertional dyspnea, Reproducible, cardiac stressors such as exercise,
strenuous activity, and the associated symptoms. Cardiac MRI may evaluate the patient's
heart with find detail, but it does not show active ischemia well, rather evidence of old MI
and ventricular wall thinning. Physical examination likewise is not very particular to
cardiac patients and their cardiac disease state, and although there may be some associated
signs, they are not specific. Echocardiogram is also useful tool to evaluate ejection fraction
and valve/wall function, but this is not showcase ischemia well.
,Your patient is complaining of paroxysmal atrial fibrillation. Which medical procedure is
commonly used to treat this condition?
Cryoablation of the transition zone of the left pulmonary vein inflow to the left atrium
Placement of biventricular pacing
Radio frequency ablation of the left ventricular apex
Overdrive pacing via an epicardial lead. ANSWER - Cryoablation of the transition zone of
the left pulmonary vein inflow to the left atrium
Rationale: The transition zone of pulmonary vein to left atrium represents the most
common source of atrial fibrillation and is commonly treated with scarification, radio
frequency ablation, or cryotherapy to impede the electrical stimulation of a-fib to the rest of
the atrium.
Wrong answerQuestion pts
Your patient with a history of two coronary stents and a LDL of 190 has been started on
lipid-lowering statin therapy on three separate attempts with considerable side effects such
as leg pain and in one event, hospitalization for rhabdomyolysis. Which is the best option
moving forward to manage their lipids?
Initiate PCSK9 Inhibitor therapy
Use ezetimibe as monotherapy
Reattempt statin therapy
Aspiring 81mg daily. ANSWER - Initiate PCSK9 Inhibitor therapy
Rationale: Aspirin is not considered a lipid lowering agent. History of statin-induced
rhabdomyolysis is a contraindication for further statin attempts. Ezetimibe as monotherapy
does not provide any appreciable decrease in LDL to goal of <100 for proven CAD (patient
has stents in place). PCSK9 Inhibitors are the best available drug class for this patient.
Wrong answerQuestion pts
Which of the following medications does not cause beta 1 stimulation?
dobutamine
phenylephrine
epinephrine
dopamine. ANSWER - Phenylepherine
Rationale: Phenylephrine only stimulates alpha 1 receptors. The remaining three all have
beta receptor activity.
, The suggested International Normalized Ratio (INR) range in a patient being treated for
atrial fibrillation is:
1.0-2.0
3.0-4.0
2.0-3.0
4.0-5.0. ANSWER - 2.0-3.0
Rationale: 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 of 2.0,
think of the patient as twice as thin for their blood as their normal. Protime can also be used
to evaluate bleeding time for warfarin patients, but has in general been replaced many years
ago by the INR as the standard measurement, where PTT (partial thromboplastin time) or
Anti-Xa are more useful for evaluating bleeding times related to Heparin therapy.
A 35-year-old woman with a history of hypothyroidism presents with fatigue, weight gain,
constipation, and cold intolerance. Her TSH level is elevated, and her free T4 is low. What
is the most appropriate next step in management?
Increase levothyroxine dosage
Order an antithyroperoxidase antibody test
Refer to an endocrinologist
Start methimazole. ANSWER - Increase levothyroxine dosage
Rationale: Her clinical findings suggest she has not found a stable state (euthyroid) of her
thyroid supplementation and an increased dose should be given to reduce her cinical
findings of hypothyroidism. This is supported by her TSH being elevated and the T4 being
low, both which support the patient not having enough thryoid to bring the TSH down to
normal and the T3/T4 up to normal.
An adult male who has managed type 2 diabetes mellitus well for many years presents for a
6-month follow up. His Hgb A1c has risen from 7% to 9% over the interval. All other
laboratory values are normal and his BMI is still 25. His psychiatrist recently added
olanzapine (Zypreza) to the medical regimen. The nurse practitioner will most likely:
Encourage the patient to start walking for 30 min every other day
Begin to increase the patient's diabetes medications incrementally
Encourage the patient to cut back on dietary intake
Discontinue the olanzapine until the patient's psychiatrist has been consulted. ANSWER -
Begin to increase the patient's diabetes medications incrementally
