NURS 5434 / NURS5434 CAD & Lipids Quiz – Family III (FNP 3) 2026/ 2027 | UTA Latest Update | Practice Questions & Verified Answers

NURS 5434 / NURS5434 CAD & Lipids Quiz – Family III (FNP 3) 2026/ 2027 | UTA Latest Update | Practice Questions & Verified Answers Q: Define the epidemiology of ASCVD with an emphasis on gender differences. Answer MEN: - leading cause of death; 1:4 - ETHNICITY: 1:13 white 1:14 black 1: 17 Hispanic - Half of men die suddenly of CAD had no previous symptoms Women - leading cause of death; 1:5 - ETHNICITY: leading cause of death for African American and white - 1:30 asian - 64% of women died suddenly of CAD had no previous symptoms - ASCVD is more prevalent in men than women, with men having a higher incidence of coronary heart disease (CHD) and stroke. - However, women with ASCVD have higher mortality rates than men, and they also tend to develop ASCVD at an older age than men. (Hormonal factors, such as estrogen, may play a role in this gender difference.) Q: WHAT IS ASCVD Answer atherosclerotic cardiovascular disease - buildup of plaque in the arteries; can cause heart attack and stroke Q: Describe the role of inflammation in the development of ASCVD. Answer A plaque is unstable due to inflammation. Statins stabilize and harden plaques, especially the lesion shoulders - interventions to decrease inflammation: include aspirin, smoking cessation, exercise, MUFAs - Chronic inflammation leads to the activation of immune cells - cause damage to arterial walls & formation of atherosclerotic plaques. - Inflammation markers: high-sensitivity C-reactive protein (hs-CRP); used as a predictor of ASCVD risk. - anti-inflammatory drugs: canakinumab (reduce risk of recurrent cardiovascular events) - statins and PCSK9 inhibitors: anti-inflammatory effects; (targeting inflammation may be an effective strategy for preventing and treating ASCVD) Q: Identify the modifiable and non-modifiable risk factors for ASCVD; know male and female ages for premature CVD vs increased risk status based on age Modifiable risk factors: Answer - Dyslipidemia (raised LDL, Low HDL, raised TGS) - Smoking - Htn - Obesity - Dietary factors - Thrombogenic factors - Sedentary lifestyle Non-modifiable: - Age: males over 45 and females over 55 - Sex - Family hx of premature CHD: Males less than 55 and females less than 65 - Definite MI or sudden death Q: Describe the effect of statins on vulnerable plaques. Answer - lower cholesterol levels and reduce the risk of ASCVD. - stabilize vulnerable plaques, which are more prone to rupture and cause heart attacks. - Statins can also reduce inflammation in the arterial walls - decrease LDL (stabilize plaques by lowering inflammation, lowering lipid accumulation, and stimulating the formation of collagen and other extracellular matrix proteins) Q: Differentiate between directing therapy to "global risk for ASCVD" vs. "LDL targets". Answer Managing global CVD includes - HTN control - Tobacco cessation - Lifestyle: weight and exercise - Healthy diet - Stress management Global risk assessment risk factors to estimate risk of developing ASCVD: - age, sex, BP, cholesterol levels, smoking, and DM (Treatment recommendations based on estimated risk) LDL targets: - focus specifically on lowering LDL regardless of an individual's overall risk of ASCVD - LDL targets have been used in the past, current guidelines emphasize the use of global risk assessment to guide treatment decisions Q: Describe the role of the non-statin drugs (Fibrates & Niacin) for lipid problem. (Gemfibrozil & Fenofibrate) Answer Fibrates: Gemfibrozil- Should NOT be initiated in statin users because it can affect statin pathways Fenofibrate- - Should not be used in patients with GFR less than 30 ml/min - May be considered for use in low or moderate intensity statin users if trig is greater than 500 or ASCVD reduction deemed beneficial - Not a replacement treatment for statins Q: Describe the role of the non-statin drugs (Fibrates & Niacin) for lipid problem. Answer used to treat lipid problems (high triglyceride levels and low HDL) - Fibrates: activating receptor that incr breakdown of triglycerides and promotes production HDL; RISK- gallstones - Niacin: incr HDL & can lower LDL (less commonly used than statins, associated w/ side effects and overall benefit in reducing ASCVD risk has not been as well established); RISK- liver toxicity If unable to take statins or continue have lipid abnormalities while taking statins could benefit; adjunctive therapy Q: Describe the role of the non-statin drugs (FIBRATES & Niacin) for lipid problem. PCSK9 inhibitors Answer PCSK9 inhibitors: - Reduce degradation of hepatic LDL receptors so they lower LDL - Very expensive - Injectable sq every 2 weeks - Alirocumab and evolocumab - CV events nearly reduced by 50% Q: Identify the major recommendations in the 2018 Cholesterol Guidelines that build on the 2013Guidelines. Answer Describe the role of ezetimibe and the PCSK9 inhibitors advanced in the 2018 guidelines. Identify the recommended follow up labs for statin mgt monitoring. Define statin intolerance due to muscle symptoms and 3 recommended management options. Describe what non-HDL cholesterol measures and its implications. Apply patient data to the ASCVD pooled estimate calculator to determine global risk and recommendthe appropriate pt management. Download this from the app store or ACC/AHA Define the four major statins benefit groups identified in 2013 AHA/ACC Cholesterol Guidelines. Define the two new 2018 subcategories for those with ASCVD: very high risk and high risk. Define the six high risk variables (2013 guidelines) known as enhanced Risk Factors in 2018 guidelinesthat may support the use of statins when the calculator is 7.5%. Describe the possible use of coronary artery calcium (CAC) scoring in 2018 guidelines. Differentiate between high and moderate intensity statins by drug and dose. Using clinical scenarios, calculate risk level and recommend therapy. Define hazards of elevated lipids in children. Apply universal guidelines for screening for lipid abnormality. Define the role of non-HDL cholesterol in lipid screening. Describe lifesyle mgt for children to reduce lipids. Describe medical mgt to treat dyslipidemia and indications for this. LIPID PANNEL: Normal levels (BOARD REVIEW) "Think 2, 4, 6..." Total Cholesterol: 200 HDL: 40-60 (40 +60= 100, tip to remember LDL) LDL: 100 Triglycerides: 150 LIPID PANNEL: ASCVD cutoff to start meds (BOARD REVIEW) Answer 7.5% LIPID PANNEL: how often to check (BOARD REVIEW) Answer q5yr unless has incr risk factors (ex. high BMI, family hx of MI)= check more frequently! LIPID PANNEL: treatment first line (BOARD REVIEW) Answer always start with lifestyle modifications before meds LDL (BOARD REVIEW) LOW-DENISITY LIPOPROTEIN - Makes up most of your body's cholesterol - high LDL levels raise your risk for heart dz & stroke HDL (BOARD REVIEW) HIGH-DENSITY LIPOPROTEIN - Absorbs cholesterol and returns to liver - high levels HDL levels lower your risk heart dz & stroke WHEN TO START STATIN MED (BOARD REVIEW) If any of the following apply, consider adding STATIN: - h/o MI - LDL 190 w/ co-morbidities - adults 40-75yo w/ DM - adults 40-75yo w/ ASCVD 7.5% HIGH-INTENSITY STATIN: first line treatment (BOARD REVIEW) HMG-COA REDUCTASE INHIBITORS - works to reduce LDL CRITERIA FOR HIGH-INTENSITY STATIN (BOARD REVIEW) If LDL 190 w/ other co-morbidities (CAD, DM, CKD) or if 65yo STRONGEST STATINS (BOARD REVIEW) ROSUVASTATIN (CRESTOR): 20-40mg/d "SU" rhymes w/ 2 ATORVSTATIN (LIPITOR): 40-80mg/d "TOR" rhymes w/ 4 TWO MAJOR SIDE EFFECTS TO STATINS (BOARD REVIEW) RHABDOMYOLYSIS: Key finding- muscle pain Labs- elevated CK (5x normal!) Risks- acute renal failure! DRUG-INDUCED HEPATITIS: Key findings- Juandice Labs: elevated LFT's Education: avoid grapefruit! - both may present w/ dark urine (use key findings for differentiation) - Testing tip: check baseline CK, LFT's, HBA1C INITIATE TREATMENT WHEN TRIGLYCERIDES ARE (BOARD REVIEW) 500 NORMAL TRIGLYCERIDE LEVELS (BOARD REVIEW) 150 FIRST LINE TREATMENT FOR ELEVATED TRIGLYCERIDES (BOARD REVIEW) FENOFIBRATE HIGH RISK FOR: Pancreatitis (If levels 1000, almost inevitable will develop) HIGH INTENSITY STATINS ROUVASTATIN & ATORAVASTATIN at appropriate doses Statin guidelines recommend secondary prevention patients achieve an LDL of: 70 Most patients who have difficulty tolerating a statin can be helped with a different statin or some type of lower dosing. (TRUE/FALSE) TRUE Statins can cause T2DM. However, most of the affected patients had several risk factors for diabetes already in place. (TRUE/FALSE) TRUE Patients with an intermediate risk for CVD (7.5% to 19.9%) who have metabolic syndrome may be good candidates for a statin. YES, A STATIN CAN REDUCE RISK Metabolic syndrome is judged by 5 criteria. These criteria do NOT include: ELEVATED LDL CORRECT CRITERIA: 1) ELEVATED BG 2) HTN 3) DECR HDL & INCR TRYGLYCERIDES A family history of premature heart disease should always be elicited and documented in the diagnosis list as it i a significant risk factor for Heart disease. It is defined as: MEN 55YO FEMALE 65YO Patients considered secondary prevention means they have established CVD. What is the recommendation for their use of a statin? HIGH INTENSITY STATIN Patients who are considered primary prevention for CVD and statin use include all EXCEPT: SEVERE HTN CORECT CRITERIA: LDL 190 CVD RISK SCORE 7.5% DM MIs occur due to rupture of plaques in blood vessels that are _____ occluded: 50% Most MIs occur due to unstable coronary artery plaques. Statins help to harden and stabilize these plaques. (TRUE/FALSE) TRUE The U.S. age adjusted death rates for Heart Disease by race and ethnicity in descending order are: (2019) BLACK, WHITE, HISPANIC, ASIAN Who should be receiving statin therapy per the 2018 Cholesterol Guidelines? Select the one group for whom statins are NOT indicated. HTN CORRECT CRITERIA: CLINICAL ASCVD LDL 190 DM2 (DOSING DEPENDING ON RISK) Other individuals also have a recommendation for statin therapy. Select the one group for whom statins are NOT indicated. LDL 130 CORRECT CRITERIA: RISK ABOVE 7.5% STRONG FAM HX OR H/O PREMATURE HEART DZ OR CORONARY CALCIUM SCORE ELEVATED OR ENHANCED RISK FACTORS (METABOLIC SYNDROME, CKD) Individuals die suddenly of CHD with NO previous symptoms. This is scary and means NPs must identify the patient's risk factors and address them with the patient to reduce CVD risk. Which fact below is true about sudden death without any previous symptoms? MEN 50% AND WOMEN 64% DIE SUDDENLY WITH NO PREVIOUS SYMPTOMS In 2018, new cholesterol recommendations were added to those of 2013. These recommendations idientified 2 more specific risk groups for drug therapy: High Risk and Very High Risk. The 2 drugs added to statin use for these 2 groups are: EZETIMIBE & PCSK9 INHIBITOR 58 yo AA male. HTN and diabetes—no tobacco. He had a heart attack 3 years ago. Total cholesterol is 234, LDL is 140, and HDL is 38. SBP is 138 and DBP is 90. Other than HTN meds, he is taking nothing else. What drug treatment based on his global risk score will you recommend in addition to lifestyle? HIGH INTENSITY START STATIN, ASSESS 3 MONTHS, MAY NEED TO START EZETIMIBE AND CONSIDER ADDING PCSK9 INHIBITOR Research shows that we need universal screening in children to detect lipid disorders as opposed to only scrreeening those with a + family hisory. Universal non-fasting screening for non-hdl cholesterol level should be done using a lab order for TC and HDL only. Then assess that value against an appropriate chart. The recommended age levels for universal screening include 2 age groups: 9-11YO 17-21YO The 5-3-2-1-almost 0 counseling framework for children is an east to use tool in the exam room. Select the correct answer for what it means. 5- SERVING FRUITS/VEG DAILY 3- MEALS DAILY 2- HOURS OR LESS SCREEN TIME 1- PHYSICAL ACTIVITY 0- SUGAR You must involve the family in any efforts to improve a child's lipids, weight, or BP. This means education and resources to help the family. You can implement all the actions below EXCEPT to assist: TELL PARENTS AND CHILD MUST MAKE BIG CHANGES NOW CORRECT CRITERIA: - CREATE SMALL GROUP TO EDUCATE - FIND GROUP IN COMMUNITY FOR FAMILY SUPPORT - REFERRAL DIETICIAN A child 12 who needs a statin should be referred to a lipid specialist for best management. (TRUE/FALSE) TRUE