APEA EXAM #3 QUESTIONS AND ANSWERS
A patient has had poorly controlled hypertension for more than 10 years. Indicate the
most likely position of his point of maximal impulse
a. 5th intercostal space mid clavicular line
b. 8th intercostal space mid clavicular line
c. 5th intercostal space left of MCL
d. 5th intercostal space right of MCL - Answers - B
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 what?
a. Mitral valve prolapse
b. Acute mitral regurgitation
c. Chronic mitral stenosis
d. Mitral Stenosis - Answers - D
A patient with hypertension describes a previous allergic reaction to a sulfa antibiotic as
sloughing of the skin and hospitalization. Which medication is contraindicated in this
patient?
a. Lisinopril
b. Metoprolol
c. Hydrochlorothiazide
d. Verapamil - Answers - C
A 75-year old patient who has aortic stenosis wants to know what symptoms indicate
worsening of his stenosis. The nurse practitioner replies:
a. Palpitations and weakness
b. Ventricular arrhythmias
c. Shortness of breath and syncope
d. Fatigue and exercise intolerance - Answers - C
A 74-year old patient has peripheral artery disease. Which term listed below is an
important non-modifiable risk factor for PAD?
a. Cigarette smoking
b. Hyperlipidemia
c. Diabetes
d. Alcohol consumption - Answers - C
Lisinopril should be discontinued immediately if:
a. Dry cough develops
b. Pregnancy occurs
c. Potassium levels decrease
d. Gout develops - Answers - B
,The valve most commonly involved in chronic rheumatic heart disease is the:
a. Aortic
b. Mitral
c. Pulmonic
d. Tricuspid - Answers - B
A patient taking an ACE inhibitor should avoid what:
a. strenuous exercise
b. potassium supplements
c. protein rich meals
d. grapefruit juice - Answers - B
A 28-year old has a grade 3 murmur. Which characteristic indicates a need for referral?
a. A fixed split
b. An increase in splitting with inspiration
c. A split S2 with inspiration
d. Changes in intensity with position change - Answers - A
Mr. Smith is a 72-year old patient who takes warfarin for chronic atrial fibrillation. His
INR today is 4.0. The nurse practitioner should:
a. Stop the warfarin for the next four days and repeat the INR on day 5
b. admit to the hospital immediately
c. Administer Vitamin K and repeat INR in two hours
d. Stop the Warfarin today and repeat the INR tomorrow - Answers - D
According to the National Heart Lung and Blood Institute, which characteristic listed
below is a coronary heart disease risk equivalent that is which risk factor places the
patient at AC CHD risk similar to a history of CHD?
a. Hypertension
b. Cigarette smoking
c. Males over the age of 45
d. Diabetes - Answers - D
A patient diagnosed is with mild heart failure. What drug listed below would be a good
choice for reducing morbidity and mortality long-term?
a. Verapamil
b. Digoxin
c. Furosemide
d. Metoprolol - Answers - D
A patient has shortness of breath. If heart failure is the etiology which test demonstrates
the highest sensitivity in diagnosing this?
a. Echocardiogram
b. B type natriuretic peptide (BNP)
c. EKG
d. Chest X-ray - Answers - B
, A 50-year old patient with hypertension has taken hydrochlorothiazide 25mg daily for
the past four weeks. Her blood pressure has decreased from 155/95 to 145/90. How
should the nurse practitioner proceed?
a. Wait four weeks before making a dosage change
b. Increase the hydrochlorothiazide to 50mg a day
c. Add a drug from another class to the daily 25mg hydrochlorothiazide
d. Stop the HCTZ and start a drug from a different class - Answers - C
Where would the murmur associated with mitral regurgitation best be auscultated?
a. Aortic listening point
b. Microl listening point
c. Pulmonic listening point
d. Tricuspid listening point - Answers - B
What is the earliest detectable glycemic abnormality in a patient with type 2 diabetes?
a. Postprandial glucose elevation
b. Nighttime hyperglycemia
c. Fasting glucose elevation
d. Abnormal HgbA1c - Answers - A
Mr. Jones is a patient with type 2 diabetes. He brings his obese 15-year old son in to
see the nurse practitioner. You examined the 15-year old son and find acanthosis
nigricans. This probably indicates:
a. undiagnosed diabetes
b. insulin resistance
c. familial skin change
d. poor hygiene - Answers - B
A 45-year old female patient has had fatigue for the past three months and a 10 pound
weight gain. She previously had regular periods occurring about every 30 days but in
the last three months her periods have varied between 30 and 45 days. Her TSH value
is 13M LU/L. It was repeated and one week later found to be 15 M LU/L. What explains
this finding?
a. Subclinical hypothyroidism
b. Hypothyroidism
c. Transient hypothyroidism
d. Perimenopause - Answers - B
A patient who is taking long-acting basal insulin has elevated blood sugars. Which blood
sugars are important to review in order to increase the dose of insulin?
a. AM fasting
b. Two-hour postprandial
c. Preprandial
d. Bedtime - Answers - A
A patient has had poorly controlled hypertension for more than 10 years. Indicate the
most likely position of his point of maximal impulse
a. 5th intercostal space mid clavicular line
b. 8th intercostal space mid clavicular line
c. 5th intercostal space left of MCL
d. 5th intercostal space right of MCL - Answers - B
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 what?
a. Mitral valve prolapse
b. Acute mitral regurgitation
c. Chronic mitral stenosis
d. Mitral Stenosis - Answers - D
A patient with hypertension describes a previous allergic reaction to a sulfa antibiotic as
sloughing of the skin and hospitalization. Which medication is contraindicated in this
patient?
a. Lisinopril
b. Metoprolol
c. Hydrochlorothiazide
d. Verapamil - Answers - C
A 75-year old patient who has aortic stenosis wants to know what symptoms indicate
worsening of his stenosis. The nurse practitioner replies:
a. Palpitations and weakness
b. Ventricular arrhythmias
c. Shortness of breath and syncope
d. Fatigue and exercise intolerance - Answers - C
A 74-year old patient has peripheral artery disease. Which term listed below is an
important non-modifiable risk factor for PAD?
a. Cigarette smoking
b. Hyperlipidemia
c. Diabetes
d. Alcohol consumption - Answers - C
Lisinopril should be discontinued immediately if:
a. Dry cough develops
b. Pregnancy occurs
c. Potassium levels decrease
d. Gout develops - Answers - B
,The valve most commonly involved in chronic rheumatic heart disease is the:
a. Aortic
b. Mitral
c. Pulmonic
d. Tricuspid - Answers - B
A patient taking an ACE inhibitor should avoid what:
a. strenuous exercise
b. potassium supplements
c. protein rich meals
d. grapefruit juice - Answers - B
A 28-year old has a grade 3 murmur. Which characteristic indicates a need for referral?
a. A fixed split
b. An increase in splitting with inspiration
c. A split S2 with inspiration
d. Changes in intensity with position change - Answers - A
Mr. Smith is a 72-year old patient who takes warfarin for chronic atrial fibrillation. His
INR today is 4.0. The nurse practitioner should:
a. Stop the warfarin for the next four days and repeat the INR on day 5
b. admit to the hospital immediately
c. Administer Vitamin K and repeat INR in two hours
d. Stop the Warfarin today and repeat the INR tomorrow - Answers - D
According to the National Heart Lung and Blood Institute, which characteristic listed
below is a coronary heart disease risk equivalent that is which risk factor places the
patient at AC CHD risk similar to a history of CHD?
a. Hypertension
b. Cigarette smoking
c. Males over the age of 45
d. Diabetes - Answers - D
A patient diagnosed is with mild heart failure. What drug listed below would be a good
choice for reducing morbidity and mortality long-term?
a. Verapamil
b. Digoxin
c. Furosemide
d. Metoprolol - Answers - D
A patient has shortness of breath. If heart failure is the etiology which test demonstrates
the highest sensitivity in diagnosing this?
a. Echocardiogram
b. B type natriuretic peptide (BNP)
c. EKG
d. Chest X-ray - Answers - B
, A 50-year old patient with hypertension has taken hydrochlorothiazide 25mg daily for
the past four weeks. Her blood pressure has decreased from 155/95 to 145/90. How
should the nurse practitioner proceed?
a. Wait four weeks before making a dosage change
b. Increase the hydrochlorothiazide to 50mg a day
c. Add a drug from another class to the daily 25mg hydrochlorothiazide
d. Stop the HCTZ and start a drug from a different class - Answers - C
Where would the murmur associated with mitral regurgitation best be auscultated?
a. Aortic listening point
b. Microl listening point
c. Pulmonic listening point
d. Tricuspid listening point - Answers - B
What is the earliest detectable glycemic abnormality in a patient with type 2 diabetes?
a. Postprandial glucose elevation
b. Nighttime hyperglycemia
c. Fasting glucose elevation
d. Abnormal HgbA1c - Answers - A
Mr. Jones is a patient with type 2 diabetes. He brings his obese 15-year old son in to
see the nurse practitioner. You examined the 15-year old son and find acanthosis
nigricans. This probably indicates:
a. undiagnosed diabetes
b. insulin resistance
c. familial skin change
d. poor hygiene - Answers - B
A 45-year old female patient has had fatigue for the past three months and a 10 pound
weight gain. She previously had regular periods occurring about every 30 days but in
the last three months her periods have varied between 30 and 45 days. Her TSH value
is 13M LU/L. It was repeated and one week later found to be 15 M LU/L. What explains
this finding?
a. Subclinical hypothyroidism
b. Hypothyroidism
c. Transient hypothyroidism
d. Perimenopause - Answers - B
A patient who is taking long-acting basal insulin has elevated blood sugars. Which blood
sugars are important to review in order to increase the dose of insulin?
a. AM fasting
b. Two-hour postprandial
c. Preprandial
d. Bedtime - Answers - A
