3P APEA EXAM PREP QUESTIONS AND CORRECT ANSWERS WITH RATIONALES.

Difference between varicose vein and arteriosclerosis - correct answer Is the affected vessel Arteriosclerosis affects arteries whereas varicose veins affects veins A patient has poorly controlled hypertension for more than 10 years. Indicate the most likely position of his point of maximal impulse (PMI) - correct answer 5th ICS, left of MCL A 43 year old Hispanic male has an audible diastolic murmur best heard in the mitral listening point. There is no audible click. His status has been monitored for the past two years. This murmur is probably - correct answer mitral stenosis A patient who has diabetes presents with pain in his lower legs when he walks and pain resolution with rest. When specifically asked about his pain in his lower leg, he likely will report pain - correct answer in the calf muscle A patient with hypertension describes a previous allergic reaction to a sulfa antibiotic as "sloughing of skin" and hospitalization. Which medication is contraindicated in this patient? - correct answer hydrochlorothiazide A 75 year old patient who has aortic stenosis wants to know what symptoms indicate worsening of his stenosis. the NP replies: - correct answer shortness of breath and syncope A 74 year old patient has PAD. Which item listed below is an important nonmodifiable risk factor for PAD? - correct answer diabetes Benazepril should be d/c immediately if - correct answer pregnancy occurs aortic regurgitation characteristics - correct answer long asymptomatic period follow by exercise intolerance, then dyspnea at rest DVT classic symptoms - correct answer swelling, pain, and discoloration of lower extremity Characteristic of ACE-induced cough is that? - correct answer usually begins two weeks of starting therapy Valve most commonly involved in chronic rheumatic heart disease - correct answer mitral Medication that can exacerbate HF - correct answer naproxen Patient taking ACE inhibitors should avoid? - correct answer potassium supplements Grade 3 murmur indication for a referral - correct answer a fixed split Group of meds used to treat HF - correct answer fosinopril, HCTZ, verapamil Mr. Smith is a 72-year-old patient who takes warfarin for chronic A-fib. INR today is 4.0. the NP should: - correct answer stop the warfarin today and repeat INR tomorrow According to the NHLBI, which characteristic is a coronary heart disease risk equivalent, that is, which risk factor places the pt. as a CHD risk similar to a hx of CHD - correct answer diabetes mellitus good drug to reduce morbidity and mortality in mild HF - correct answer metoprolol A pt. taking atorvastatin newly diagnosed with dyslipidemia complaints of fatigue, weakness, and muscle aches in his lower back, arms, legs for the past 3 days. it is not improved with rest How should this be evaluated? - correct answer Stop the atorvastatin immediately symptom not indicative of HF - correct answer headache What class of meds is preferred to normalized lipid levels and reduce risk of cardiac events - correct answer HMG CoA reductase inhibitors Highest sensitivity in diagnosing HF - correct answer BNP The NP is caring for a 74-year-old who had an acute coronary syndrome 6 weeks ago. What medications should be part of his regimen unless contraindicated - correct answer ACE, ASA, beta blockers, and statin patient with the highest systolic B/P - correct answer 75-year-old male test that is most cost effective to screen for abdominal aortic aneurysm - correct answer abdominal ultrasound a 74-year-old patient has had an increase in b/p since the last exam. his b/p has increased from 144/90 to reading in the upper 160's/upper 80's. If medication is to be started on this patient, what would be a good first choice? - correct answer Calcium channel blocker Factor contributing to the development of AAA - correct answer cigarette smoking A 40-year-old African-American pt. has a b/p of 175/100 and 170/102. What is a reasonable plan of care for this pt today? - correct answer initiate amlodipine 5mg daily Usual course of treatment for mitral valve prolapse - correct answer is benign A 50-year-old patient with hypertension has taken HCTZ 25mg daily for the past 4 weeks. Her b/p has decreased from 155/95 to 145/90. How should the NP proceed? - correct answer add another drug from another class to the daily 25mg HCTZ A patient with mitral valve prolapse reports chest pain and frequent arrhythmias. In the absence of other cardiac anomalies, the drug of choice to treat her symptoms is: - correct answer metoprolol which hypertensive pt. is most likely to have adverse b/p effects from excessive sodium consumption? - correct answer a 70-year-old African American where would the murmur associated w/mitral regurgitation best be auscultated? - correct answer mitral listening point A pt. with a positive hx of a tick bite 2 weeks ago and erythema migrans has a positive ELISA for borrelia burgdorferi. The Western blot is positive. How should he be managed? - correct answer he should receive Doxycycline for Lyme disease a pt. has/seborrheic dermatitis. Which vehicle would be most appropriate to use in the hairline area to treat this? - correct answer foam A microscopic exam of the sample taken from a skin lesion indicates hyphae. What type of infection might this indicate? - correct answer fungal A pt. has been dx w/MRSA. she is allergic to sulfa. Which medication could be used to treat her? - correct answer doxycycline A 15-year-old male has worked this summer as a lifeguard at a local swimming pool. He complains of itching in the groin area. He is dx with tinea cruris. The NP is likely to identify - correct answer well marginated half moon shape macules on the inner thigh A pt. exhibits petechiae on both lower legs w/o other complaints. How should the NP proceed? - correct answer order a CBC A pt. has been dx w/scabies. What is the medication of choice to treat this? - correct answer permethrin and good hand hygiene A pt. has been in the sun for the past few weeks and has developed darkened skin and numerous 3-6 mm light-colored, flat lesions on his trunk. What is the likely etiology? - correct answer tinea vesicolor Which vehicle is least appropriate in a pt. w/atopic dermatitis? - correct answer lotions a pt. presents w/small vesicles on the lateral edges of his fingers and intense itching. there are small vesicles on the palmar surface of the hand. What is this called? - correct answer dyshidrotic dermatitis a low-potency topical hydrocortisone cream would be most appropriate in a pt. who has been dx with? - correct answer atopic dermatitis most common form of skin cancer - correct answer basal cell carcinoma greatest percutaneous absorption areas in the body - correct answer genitalia most common place for basal cell carcinoma - correct answer face A 74-year-old is dx w/shingles. The NP is deciding how to best manage her care. What should be prescribed? - correct answer an oral antiviral agent the American Cancer Society uses an ABCDE Mneumonic to help pt.'s develop awareness of suspicious skin lesions what do they represent? - correct answer A= asymetry B=border C=color D=diameter E=enlarging or elevated characteristic of shingles - correct answer single dermatome affected an example of a premalignant lesion that develops on sun-damaged skin is: - correct answer actinic keratosis A patient w/Diabetes has right anterior shin edema, erythema, warmth, and tenderness to touch. This developed over the past 3 past. There is no visible pus. What is the most likely diagnosis to consider? - correct answer cellulitis