NURS 5463 Test 4 practice Questions with well explained 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? - 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? - A. Medical management Which of the following statements regarding carotid artery stenting is most accurate? - 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? - A. Coumadin to target an INR of 2 to 3 For which of the following patients is a left carotid endarterectomy most indicated? - A. A 70-yearold 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 - 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 ona 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? - 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? - Aspirin to chew In the initial evaluation of a patient with chest pain, which is the most important diagnostic test? - 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? - 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? - 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? - A Percutaneous coronary angiography Which of the following statements regarding out-of-hospital sudden cardiac arrest (SCA) is true? - E Therapeutic hypothermia improves neurological outcome after SCA in patients with depressed mental status after resuscitation. What type of MI is this II, III, AvF - C. InferiorA 59-year-old man complains of severe chest pain that radiates to his back. His brachial pulses appear unequal between his right and left arms. He appears hemodynamically stable. On chest radiography, he has a widened mediastinum. Which of the following is the best next step? - B Obtain CT of chest with intravenous contrast. A 45-year-old woman with new-onset aortic regurgitation is found to have aortic dissection of the ascending aorta and aortic arch by TEE. She is relatively asymptomatic. Which of the following is the best management? - C Surgical repair of the dissection A 61-year-old man is found on physical examination to have an asymptomatic AAA. Ultrasound evaluation reveals that the AAA measures 4 cm in diameter. Which of the following is the best surveillance strategy for his AAA? - D Ultrasound evaluation every year Which of the following is a known complication associated with AAA? - Painful discoloration of the great toe Which of the following statements is true regarding EVAR? - Most EVAR complications do not require open interventions For which of the following patients is nonoperative management most appropriate? - B A 96-yearold man with severe dementia and a 6-cm AAA. The patient has been a long-term resident of a chronic care facility due to inability to care for himself secondary to his dementia A 45-year-old man with a past medical history of diabetes, hyperlipidemia, and hypertension has smoked one pack of cigarettes a day for the past 15 years and drinks four glasses of wine every weekend. He is found to have an AAA incidentally on CT imaging of the abdomen. Which of the following is the most important predisposing factor for the development of his AAA? - B Smoking A 68-year-old man with a history of end-stage renal disease is admitted to the hospital for chest pain. On examination, a pericardial friction rub is noted. His ECG shows diffuse ST-segment elevation. Which of the following is the best definitive treatment? - Dialysis The same is now hospitalized, but there is a delay in initiating treatment. You are called to the bedside because he has become hypotensive with a systolic blood pressure of 85/68 mm Hg, a heart rate of 122 bpm, and pulsus paradoxus. A repeat ECG is unchanged from admission. Which of the following is themost appropriate immediate intervention? - Perform echocardiographic-guided pericardiocentesis. A 62-year-old man is evaluated for a 7-month history of progressive dyspnea and lower extremity swelling. His medical history is significant for lymphoma treated with chest irradiation 15 years ago and currently in remission. He does not smoke or drink alcohol. On physical exam, vital signs are stable. There is jugular venous distension and jugular venous engorgement with inspiration. Cardiac exam discloses a prominent early diastolic sound but no murmurs or gallops. Lung exam reveals normal breath sounds. Abdominal examination reveals ascites, and lower extremities show 3+ pitting edema. ECG shows normal sinus rhythm with nonspecific diffuse ST-T changes. Urinalysis is normal. Chest radiography shows calcifications around the heart and clear lung fields. Which of the following is the most likely diagnosis? - Constrictive pericarditis A 35-year-old woman is being seen for shortness of breath of 2 weeks' duration. She denies a history of asthma, smoking, or cough. On examination, her heart rate is 100 bpm, blood pressure is 90/60 mm Hg, and respiratory rate is 20 breaths per min. Her jugular venous pulse was noted at rest to be 2 cm above the sternal notch, increasing to 6 cm above the sternal notch with deep inspiration. Which of the following conditions does she most likely have? - Constrictive pericarditis