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

NURS 5434 / NURS5434 CAD & Lipids Module 3 Exam – Family III (FNP 3) 2026/ 2027 | UTA Latest Update | Practice Questions & Verified Answers Q: T/F: In the US, more men than women die of CVD (cardiovascular disease) Answer False Q: In US women, what is the approximate ratio of deaths caused by CVD (cardiovascular disease)? Answer 1 in 5 Q: 75% of myocardial infarctions occur due to rupture of plaques in blood vessels that are ___ occluded. Answer Less than 50% Q: Stress tests do not identify obstruction until a ___ lesion is present. Answer 70-75% Q: A plaque is unstable due to ___. Answer Inflammation Q: Statins ___ & ___ plaques, especially at the lesion shoulders (outside borders or edges of vessels) Answer Stabilize & harden Q: T/F: Hardened plaques are much less likely to rupture Answer True, they are stabilized Q: What interventions decrease inflammation? Answer SWAME - Smoking cessation - Weight loss - ASA -MUFAs (mono-unsaturated fatty acids, like Omega-3s) - Exercise Q: How many distinct families of coronary lesions are there? Answer 1. Severe obstruction 2. Mild obstruction Q: Coronary Lesions: What are the characteristics of severe obstruction? Answer - Angina - May never rupture Q: Coronary Lesions: What are the characteristics of mild obstruction? Answer - No angina - Unstable or soft plaques that are likely to rupture Q: What is the definition of dyslipidemia? Answer An excessive accumulation of one or more of the major lipids transported in plasma (LDL and/or TGs), or a decrease in HDL Q: Modifiable Risk Factors for CHD: Describe dyslipidemia Answer - Raised LDL Q: Modifiable Risk Factors for CHD: Name 8 other RFs Answer SHODDDTS 1. Smoking 2. HT (Hypertension) 3. Obesity 4. DM (diabetes mellitus) 5. Dyslipidemia(raised LDL, Low HDL, raised TGS 6.Dietary factors 7. Thrombogenic factors 8. Sedentary lifestyle Q: Non-Modifiable Risk Factors for CHD: Age Answer Males aged 45 or older Females aged 55 or older Q: Non-Modifiable Risk Factors for CHD: Gender Answer Males tend to be higher risk than females Q: Non-Modifiable Risk Factors for CHD: Describe Family History of Premature CHD Answer When a first degree relative have a definite MI or sudden death in males younger than 55 and females younger than 65 Q: What are people starting to call a sedentary lifestyle in reference to health? Answer Sedentary death sentence Q: What is your goal as an NP in regards to CVD? Answer Reduce and/or prevent CVD NOTE: Treatment to no longer just management of cholesterol, a global treatment is recommended Q: According to the new perspective on lipid goals, what trial evidence shocked the medical community? Answer No RCT (clinical trials) evidence to support continued use of LDL targets Q: According to the new perspective on lipid goals, what should evaluation/treatment be geared to? Answer Global risk assessment for ASCVD (atherosclerotic cardiovascular disease) Q: How many statin benefit groups are there? Answer 4 Q: What are the four statin benefit groups? Answer 1. Established ASCVD 2. LDL greater than 190 mg/dL 3. Diabetic patients aged 40-75 4. 10-year ASCVD risk greater than 7.5% Q: what group(s) of people are excluded from the four statin benefit groups? Answer Patients with heart failure symptoms or those on dialysis What is the LDL-C reduction goal for high-intensity statin drugs? Answer Greater than 50% What is the LDL-C reduction goal for moderate-intensity statin drugs? Answer 30-50% What is the LDL-C reduction goal for low-intensity statin drugs? Answer Less than 30% What are the two high-intensity statin drugs and their dosing? Answer - Atorvastatin 80mg - Rosuvastatin 20mg Group 1 - Established ASCVD: What is the first choice of therapy? Answer High-intensity for patient less than 75 years, moderate-intensity for patient than 75 years Group 1 - Established ASCVD: What is the second choice of therapy? Moderate-intensity for patients less than 75 years, Individualized therapy for patient more than 75 years Group 2 - Hyperlipidemia: What should be considered when treating this group? Discover the cause of the hyperlipidemia. If the cause (ex: diet, drugs, disease, etc.) can be determined and corrected, statin therapy may not be needed Group 2 - Hyperlipidemia: If a patient also has elevated TGs (triglycerides), what may be the cause? Excessive alcohol intake Group 2 - Hyperlipidemia: If a patient has FH (familial hyperlipidemia) what evaluations should be done? Evaluation of family for hyperlipidemia, especially patient's children, parents, and grandparents Group 2 - Hyperlipidemia: What is a reasonable starting treatment? High-intensity statin Group 3 - Patients with diabetes aged 40-75: What is the guideline for treatment recommended by the ADA Standard of Care Moderate-intensity statin treatment to all diabetic patients regardless of baseline LDL-C Group 3 - Patients with diabetes aged 40-75: If the patient also has a 10 year ASCVD risk of greater than 7.5%, what should the treatment be? High-intensity statin Group 4 - 10 year ASCVD Risk greater than 7.5%: What treatment should be recommended? Moderate- to high-intensity statin, depending on risk factors If a patient has a a 10 year ASCVD Risk of 5-7.5%, what can be recommended? Moderate-intensity statin if the patient has other risk factors What are the specifics used in the new risk calculator for 10 year CVD risk? - Gender - Race - Ages 40-80 If a patient has a low risk score, how often should they be reassessed for a new score? 4-6 years When should a patient follow up and be tested after starting statin therapy? 6-12 weeks to repeat lipid test to monitor adherence How often should lipid testing be done thereafter? 3-12 months (although not necessary if med complaint) Fibrates: What should be remembered with Gemfibrozil? NEVER give it with a statin, can be life-threatening(affects statin pathway) Fibrates: What should be remembered with Fenofibrate? Should not be used in patients with GFR less than 30 mL/min Fibrates: When can Fenofibrate be considered for therapy? If the patient is already using low- or moderate-intensity statins New Therapy - PCSK9: What are two drugs in this category? - Alirocumab - Evolocumab What are some positives of therapy with Alirocumab or Evolocumab? - Lower LDL - CV events lowered by nearly 50% What are some negatives of therapy with Alirocumab or Evolocumab? - Very expensive - Only available in SQ injectable What are some unknowns of therapy with Alirocumab or Evolocumab? Further research needed to assess effects on global risk 2018 Guidlines - Group 1 ASCVD has been split into subgroups, what are they? - Very high risk - High risk Group 1 - ASCVD High Risk: What is the treatment? Ezetimibe in addition to high-intensity statin therapy Group 1 - ASCVD Very High Risk: What is the treatment? PCSK9 medication in addition to Ezetimibe and high-intensity therapy What factors determine if a patient is a High Risk vs Very High Risk? High risk - After high-intensity statin therapy, the LDL is greater than 70 or there is less than 50% drop Very high risk - After high-intensity statin therapy and addition of Ezetimibe, the LDL is greater than 70 Non-modifiable risk factors of ASCVD - 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 True or false Fibrates are a replacement for statin False (Fibrates are NOT a replacement treatment for statins!!!) What are SAMS Statin Associated Muscle Symptoms(SAMS)-Muscle symptoms reported during statin therapy but not necessarily caused by the statin What is Myalgia ? Muscle pain or aches What is Myopathy? Unexplained muscle pain or weakness accompanied by CK concentration 10 timesULN What is Rhabdomyolysis ? Severe form of myopathy, with CK typically 40times ULN, which can cause myoglobinuria and acute renal failureCK What are examples of Lipophilic statins (Fat loving statins) SLAPF - Simvastatin - Lovastatin - Atorvastatin - Pitavastatin -Fluvastatin What are examples of Hydrophilic Statins(Water loving statin) Pravastatin Rosuvastatin High intensity statins include: A. Atorvastatin and pravastatin B. Rosuvastatin and Atorvastatin at appropriate doses C. Simvastatin and Atorvastatin B. Rosuvastatin and Atorvastatin at appropriate doses Statin guidelines recommend secondary prevention patients achieve an LDL of: A. 100 B. 130 C. 70 70 Most patients who have difficulty tolerating a statin can be helped with a different statin or some type of lower dosing. A. True B. False C. Research is undecided about this. A. True Statins can cause T2DM. However, most of the affected patients had several risk factors for diabetes already in place. A. False B. True B. True Patients with an intermediate risk for CVD (7.5% to 19.9%) who have metabolic syndrome may be good candidates for a statin. A. No, metabolic syndrome has nothing to do with CVD risk. B. Yes. A statin can reduce their risk. c. The calculated risk of CVD has to be higher than 20%. B. Yes. A statin can reduce their risk. Metabolic syndrome is judged by 5 criteria. These criteria do NOT include: A. Elevated LDL B. Hypertension C. Decreased HDL and increased Triglycerides D. Elevated BG A. Elevated LDL 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: A. Males 60years and females 70 years B. Males 55 years and females 65 years C. Males 45 years and females 55 B. Males 55 years and females 65 years Patients considered secondary prevention means they have established CVD. What is the recommendation for their use of a statin? A. Moderate intensity statin B. Too late to stop their CVD so no need for prevention C. High intensity statin C. High intensity statin Patients who are considered primary prevention for CVD and statin use include all EXCEPT: A. LDL 190 B. Calculated CVD risk score of 7.5% C. Severe HTN D. Diabetes C. Severe HTN MIs occur due to rupture of plaques in blood vessels that are _____ occluded: A. 50% B. 75% C. 90% D. 25% A. 50% Most MIs occur due to unstable coronary artery plaques. Statins help to harden and stabilize these plaques. A. False--It's all about the LDL level not the plaque B. True--another reason to use statins other than to lower atherogenic particles True--another reason to use statins other than to lower atherogenic particles The U.S. age adjusted death rates for Heart Disease by race and ethnicity in descending order are: (2019) A. Black, not Hispanic/ White, not Hispanic/. Hispanic/. Asian or pacific islander B. Hispanic/ Black, not Hispanic/. Asian or pacific islander/ White, not Hispanic C. Black, not Hispanic;/ Hispanic/ Asian or pacific islander/ White, not Hispanic D. White, not Hispanic/ Hispanic/ Black, not Hispanic/ Asian or pacific islander A. Black, not Hispanic/ White, not Hispanic/. Hispanic/. Asian or Pacific islander Who should be receiving statin therapy per the 2018 Cholesterol Guidelines? Select the one group for whom statins are NOT indicated. A. LDL 190 B. T2DM--dosing will depend on calculated risk score C. Clinical ASCVD D. Hypertension D. Hypertension Other individuals also have a recommendation for statin therapy. Select the one group for whom statins are NOT indicated. A. Individuals should be considered with strong family history or History of premature heart disease, a Coronary Calcium Score (CCS) that is elevated or other Enhanced Risk Factors such as metabolic syndrome, CKD. Please review the other indications. B. Individuals with an LDL 130 C. Individuals with a calculated risk score of 7.5% B. Individuals with an LDL 130 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? A. 50% of men and 10% of women died suddenly of CHD had NO previous symptoms. B. 50% of men and 64% of women who died suddenly of CHD had NO previous symptoms . C. 20% of men and 80% of women died suddenly of CHD had NO previous symptoms. B. 50% of men and 64% of women who died suddenly of CHD had 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: A. Ezetimibe and PCSK9-Inhibitors B. Double doses of high intensity statins Fenofibrates A. Ezetimibe and PCSK9-Inhibitors CALCULATE THE FOLLOWING CASE TO DETERMINE GLOBAL RISK USING THE DOWNLOADED ASCVD CALCULATOR. 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? A. Control his BP better and that will address any issues. B. His LDL is not very elevated so will not need anything other than a high intensity statin. C. He is very high risk category. After starting a high intensity statin and assessing its impact for 3 months, you might add ezetimibe and after that a PCSK9-I if indicated. C. He is very high risk category. After starting a high intensity statin and assessing its impact for 3 months, you might add Ezetimibe and after that a PCSK9-I if indicated. 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: A. Age 9-11 and Age 17-21 B. Age 6-10 and Age 15-17 C. Age 5-7 and Age 10-12 A. Age 9-11 and Age 17-21 The 5-3-2-1-almost 0 counseling framework for children is an easy to use tool in the exam room. Select the correct answer for what it means. A. 5-or more servings fruits and veggies daily 3-structured meals daily 2-hours or less screen time daily 1-hour or more moderate to vigorous physical activity daily almost none-limit sugar sweetened drinks to almost none daily B. 5-or fewer hours screen time daily 3-more servings fruits and veggies daily 2-or less sugar drinks daily 1-hour or more moderate to vigorous physical activity daily almost none-limit sweets to none daily A. 5-or more servings fruits and veggies daily 3-structured meals daily 2-hours or less screen time daily 1-hour or more moderate to vigorous physical activity daily Almost none-limit sugar sweetened drinks to almost none daily 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: A. Keep telling then parent and child they must make big changes now B. Create a small group in your clinical practice to educate and help family make plans C. Find parent/child groups in the community for family support D. Refer to a dietitian for personal counseling A. Keep telling then parent and child they must make big changes now A child 12 who needs a statin should be referred to a lipid specialist for best management. A. False B. True B. True