MSN-FNP Cardiovascular Exam () Questions and
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Which of the following beta-blockers is cardio selective?
A. Nadolol
B. Propanolol
C. Atenolol
D. Penbutolol - CORRECT ANSWER -C. Atenolol
Explanation: Of the beta blockers listed, atenolol is the most cardioseletive. Cardioselective
refers to the ability to affect predominately beta 1 receptors rather than beta 2 receptors. Beta 1
receptors are located mainly in the heart and mediate the sympathetic nervous system's direct
effects on the heart. Beta 2 receptors are located predominately in the peripheral vascular system
and other organs like the lungs. Although all beta-blockers affect beta receptors, some affect
subsets of receptors differently. This has a significan consequences in terms of side effects, as
beta-blockers are know to cause extra-cardiac symptoms such as worsened bronchospasms in in
asthmatics.
Nadolol, propanolol, and penbutolol are non-selective beta-blocker
For the initial pharmacological treatment of essential hypertension, which of the following
statements is true?
A. Diuretics should be the first consideration because of their effectiveness, cost, and low side-
effect profile.
B. ACE inhibitors speed the progression of moderately increased albuminuria independent of
blood pressure control in diabetic patients.
C. Alpha-blockers are of particular benefit for the treatment of hypertension in patients with
ischemic cardiomyopathy.
D. Angiotensin receptor blockers should not be used in place of ACE inhibitors in patients who
develop a cough after initiating an ACE inhibitor. - CORRECT ANSWER -A. Diuretics should
be the first considered because of their effectiveness, cost, and low side-effect profile.
Explanation: There is no evidence that alpha-blockers are of particular benefit for the treatment
of hypertension in patients with ischemic cardiomyopathy. The JNC 8 guidelines state that in the
general non-black population, including those with diabetes, initial antihypertensive treatment
,should include a thiazide-type diuretic, calcium channel blocker (CCB), angiotensin-converting
enzyme inhibitor (ACEI) or angiotensin receptor blocker (ARB). In the general black population,
including those with diabetes, initial antihypertensive treatment should include a thiazide type
diuretic or CCB. Initial treatment with a thiazide-type diuretic was more effective than CCB or
an ACEI.
A 30-year-old G1 P0 female at 35 weeks gestation complains of a headache at her routine
prenatal visit. Her blood pressure is 140/90 mmHg and urinalysis reveals 1+ protein. Which of
the following is the most appropriate step in management of this patient?
A. Emergent cesarean section delivery
B. Close follow-up of urinary protein and serum creatinine.
C. Pitocin
D. Methylopa (Aldomet) to reduce blood pressure - CORRECT ANSWER -B. Close followup of
urine protein and serum creatinine.
Explanation: The patient has evidence of preeclampsia. Symptoms of preeclampsia include
headache, and blurred vision. Preeclampsia is characterized by hypertension, proteinuria, and
edema that occur after 20 weeks' gestation. Two blood pressures readings should be measured at
least 6 hours apart. Systolic blood pressure than than or equal to 140 mm Hg or diastolic blood
blood pressure greater than or equal to 90 mm Hg is consistent with preeclampsia, for which the
cure is delivery of the fetus and placenta. Patients will demonstrate greater than 0.3 grams of
protein in a 24-hour urine specimen and frequently gain weight rapidly, from two to five lbs per
week. RUQ pain may also herald development of HELLP syndrome, characterized by hemolysis,
elevated liver enzymes, and low platelets. Preeclampsia can cause multi-organ damage, including
stroke, acute renal failure, pulmonary edema, hepatic rupture, DIC, and fetal or maternal death. If
seizures develop, the condition is known as eclampsia. Recommendations for management of
preeclampsia include bed rest with bathroom privileges: monitor platelets, urine and serum
protein, and serum creatinine: and monitor weight and blood pressure. Oral antihypertensives are
not the first line of treatment.
A 55 yo female patient with a history of hypertension controlled with HCTZ 25 mg q day
presents for a routine wellness examination. Her BMI is 30kg/m3 and her total cholesterol is 230
g/dL. How many risk factors does this patient have for CAD?
, A. 2
B. 3
C. 4
D. 5 - CORRECT ANSWER -C. 2
Explanation: The patient has 4 risk factors for CAD: women aged 55 and older; hypertension;
hyperlipidemia; and obesity. Risk factors for CAD include HTN, family history of premature
heart disease; DM; dyslopidemia; HDL cholesterol <40 mg/dL; age older than 45 years in men or
55 years in women; cigarette smoking; obesity (BMI > or = to 30); microalbuminuria; carotid
artery disease; peripheral arterial disease. Some patients without CAD are at an increased risk of
MI as the result of other conditions. Patients with the following conditions have greater than 20%
chance of developing coronary heart disease in ten years:
CAD, PAD, abdominal aortic aneurysm, CKD, diabetes, and cigarette smoking. These conditions
are known as coronary risk equivalents and patients with these conditions should be treated as
though they have preexisting CAD.
A 54 yo male is discharged from the hospital after experiencing an MI. Past medical history
includes asthma, HTN, hyperlipidemia, and DM. He presents to PCP for an intial followup and
complains of increasing wheezing and SOB. Cardiovascular exam shows a regular rate and
rhytms without murmur/gallp/rubs and no elevated JVD. Pulmonary exam shows wheezing in all
lung fields and a prolonged expiratory phase. Which of the patient's medications are likely to
blame?
A. Lisinopril
B Rosuvastatin
C. Clopidogrel
D. Metoprolol tartrate - CORRECT ANSWER -D. Metoprolol tartrate
Explanation: This patient has likely experienced a side effect of a new cardiac medication. His
wheezing on exam could be cardiac wheezing if he was volume overloaded, but he shows no
signs of this condition. The most likely explanation is that his known asthma has flared.
Medications that induce bronchoconstriction can do this, and the mostly likely is metoprolol
tartrate. This patient's beta-blocker dose should be adjusted, or he should e trialed on a different
beta-blocker.
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Which of the following beta-blockers is cardio selective?
A. Nadolol
B. Propanolol
C. Atenolol
D. Penbutolol - CORRECT ANSWER -C. Atenolol
Explanation: Of the beta blockers listed, atenolol is the most cardioseletive. Cardioselective
refers to the ability to affect predominately beta 1 receptors rather than beta 2 receptors. Beta 1
receptors are located mainly in the heart and mediate the sympathetic nervous system's direct
effects on the heart. Beta 2 receptors are located predominately in the peripheral vascular system
and other organs like the lungs. Although all beta-blockers affect beta receptors, some affect
subsets of receptors differently. This has a significan consequences in terms of side effects, as
beta-blockers are know to cause extra-cardiac symptoms such as worsened bronchospasms in in
asthmatics.
Nadolol, propanolol, and penbutolol are non-selective beta-blocker
For the initial pharmacological treatment of essential hypertension, which of the following
statements is true?
A. Diuretics should be the first consideration because of their effectiveness, cost, and low side-
effect profile.
B. ACE inhibitors speed the progression of moderately increased albuminuria independent of
blood pressure control in diabetic patients.
C. Alpha-blockers are of particular benefit for the treatment of hypertension in patients with
ischemic cardiomyopathy.
D. Angiotensin receptor blockers should not be used in place of ACE inhibitors in patients who
develop a cough after initiating an ACE inhibitor. - CORRECT ANSWER -A. Diuretics should
be the first considered because of their effectiveness, cost, and low side-effect profile.
Explanation: There is no evidence that alpha-blockers are of particular benefit for the treatment
of hypertension in patients with ischemic cardiomyopathy. The JNC 8 guidelines state that in the
general non-black population, including those with diabetes, initial antihypertensive treatment
,should include a thiazide-type diuretic, calcium channel blocker (CCB), angiotensin-converting
enzyme inhibitor (ACEI) or angiotensin receptor blocker (ARB). In the general black population,
including those with diabetes, initial antihypertensive treatment should include a thiazide type
diuretic or CCB. Initial treatment with a thiazide-type diuretic was more effective than CCB or
an ACEI.
A 30-year-old G1 P0 female at 35 weeks gestation complains of a headache at her routine
prenatal visit. Her blood pressure is 140/90 mmHg and urinalysis reveals 1+ protein. Which of
the following is the most appropriate step in management of this patient?
A. Emergent cesarean section delivery
B. Close follow-up of urinary protein and serum creatinine.
C. Pitocin
D. Methylopa (Aldomet) to reduce blood pressure - CORRECT ANSWER -B. Close followup of
urine protein and serum creatinine.
Explanation: The patient has evidence of preeclampsia. Symptoms of preeclampsia include
headache, and blurred vision. Preeclampsia is characterized by hypertension, proteinuria, and
edema that occur after 20 weeks' gestation. Two blood pressures readings should be measured at
least 6 hours apart. Systolic blood pressure than than or equal to 140 mm Hg or diastolic blood
blood pressure greater than or equal to 90 mm Hg is consistent with preeclampsia, for which the
cure is delivery of the fetus and placenta. Patients will demonstrate greater than 0.3 grams of
protein in a 24-hour urine specimen and frequently gain weight rapidly, from two to five lbs per
week. RUQ pain may also herald development of HELLP syndrome, characterized by hemolysis,
elevated liver enzymes, and low platelets. Preeclampsia can cause multi-organ damage, including
stroke, acute renal failure, pulmonary edema, hepatic rupture, DIC, and fetal or maternal death. If
seizures develop, the condition is known as eclampsia. Recommendations for management of
preeclampsia include bed rest with bathroom privileges: monitor platelets, urine and serum
protein, and serum creatinine: and monitor weight and blood pressure. Oral antihypertensives are
not the first line of treatment.
A 55 yo female patient with a history of hypertension controlled with HCTZ 25 mg q day
presents for a routine wellness examination. Her BMI is 30kg/m3 and her total cholesterol is 230
g/dL. How many risk factors does this patient have for CAD?
, A. 2
B. 3
C. 4
D. 5 - CORRECT ANSWER -C. 2
Explanation: The patient has 4 risk factors for CAD: women aged 55 and older; hypertension;
hyperlipidemia; and obesity. Risk factors for CAD include HTN, family history of premature
heart disease; DM; dyslopidemia; HDL cholesterol <40 mg/dL; age older than 45 years in men or
55 years in women; cigarette smoking; obesity (BMI > or = to 30); microalbuminuria; carotid
artery disease; peripheral arterial disease. Some patients without CAD are at an increased risk of
MI as the result of other conditions. Patients with the following conditions have greater than 20%
chance of developing coronary heart disease in ten years:
CAD, PAD, abdominal aortic aneurysm, CKD, diabetes, and cigarette smoking. These conditions
are known as coronary risk equivalents and patients with these conditions should be treated as
though they have preexisting CAD.
A 54 yo male is discharged from the hospital after experiencing an MI. Past medical history
includes asthma, HTN, hyperlipidemia, and DM. He presents to PCP for an intial followup and
complains of increasing wheezing and SOB. Cardiovascular exam shows a regular rate and
rhytms without murmur/gallp/rubs and no elevated JVD. Pulmonary exam shows wheezing in all
lung fields and a prolonged expiratory phase. Which of the patient's medications are likely to
blame?
A. Lisinopril
B Rosuvastatin
C. Clopidogrel
D. Metoprolol tartrate - CORRECT ANSWER -D. Metoprolol tartrate
Explanation: This patient has likely experienced a side effect of a new cardiac medication. His
wheezing on exam could be cardiac wheezing if he was volume overloaded, but he shows no
signs of this condition. The most likely explanation is that his known asthma has flared.
Medications that induce bronchoconstriction can do this, and the mostly likely is metoprolol
tartrate. This patient's beta-blocker dose should be adjusted, or he should e trialed on a different
beta-blocker.
