Question 1. Question :
A 35 year old female arrives at your clinic. She has had diabetes and peripheral artery disease for the
past 5 years. You decide to obtain an ETT. The insurance company argues that this is inappropriate. You
justify the ETT because you are planning secondary strategies to prevent future heart disease. Where
could one find the supporting data for these guidelines?
Medicare guidelines
xFramingham risk score (These guidelines come from the Framingham risk score.)
Medicaid guidelines
Do not exist
Question 2.
You are counseling a patient diagnosed with stress-induced ischemia. You base your discussion on your
knowledge that stress-induced ischemia is thought to be caused by what phenomena?
Diet and exercise
Heart muscle dysfunction
Too many carbonated drinks
xEndothelial dysfunction of the microvascular (You base your discussion on your knowledge that stress-
induced ischemia is thought to be caused by endothelial dysfunction of the microvascular.)
Question 3.
What happens to coronary flow related to CAD?
Hyper profusion of the myocardium
Cerebral vascular infarction
xHypo profusion of the myocardium (Because of the restrictive flow of blook through the coronary
arteries, hypo profusion of the myocardium results from coronary flow related to CAD which causes the
presenting symptoms)
Functional systolic pressures
Question 4:
A 47-year old female with general complaints of fatigue and shortness of breath shows up in your clinic
as a referral from another nurse practitioner. Several blood tests and chest x-rays have been completed
without any diagnosis or outstanding abnormalities. You decide to order an ETT despite the fact that the
recent ECG does not show any abnormalities. From the answers below, which would be the best answer
to support your decision?
You are out of other options
,Women present with the same pattern of CAD as do males
xCAD in women is under diagnosed (You make this choice because you are aware that CAD in women is
under diagnosed.)
To please the patient
Question 5:
You are in the clinic with your mentor observing the Echocardiogram exercise test of a 45-year old male
that has been experiencing slight chest pressure almost daily during exercise. While observing your
patient, your mentor points out that the left ventricle wall is thinning and there is some hyperkinesias of
the ventricular wall. From your time in the clinic, you know that this test will be considered to be what
type of result?
Impossible
Negative
xPositive (From your time in the clinic, you know because of wall thinning and hyperkinesis that this test
will be considered to be positive.)
Non-readable
Question 6:
On the echocardiography during the ETT you notice the following change: abnormal left ventricular
ejection fraction. What do these changes suggest related to this patient?
Non-ischemic changes of the baseline ECG
xIschemia of the myocardium (Abnormal left ventricular ejection fraction suggests ischemia of the
myocardium.)
Rise in heart rate without evidence of ischemia
Weak ventricular muscles
Question 7:
Population disease management is a term used to describe:
High specificity disease states
Low specificity diseases states
Low prevalence specific diseases
xHigh prevalence specific diseases (Population disease management is a term used to describe the high
prevalence of specific diseases.)
Question 8:
Why would inability to exercise reduce the specificity of the routine ETT?
,Causes ST-segment changes and P-wave abnormalities
Will not produce any changes in ECG
xProduces persistent ST-segmental changes and T-wave abnormalities (The inability to exercise reduces
the specificity of the routine ETT because it produces persistent ST-segmental changes and T-wave
abnormalities.)
Produces QRS changes that cannot be interpreted
Question 9:
All patients, even if asymptomatic, require risk stratification according to the Farmingham risk score. At
present, ACC/AHA guidelines, however, do not normally support stress tests for asymptomatic patients
without additional justification. From the list below, what could be used to justify an ETT in an
asymptomatic patient?
xSedentary and wishes to begin aggressive exercise (Many patients have underlying CAD but remain
asymptomatic. Before beginning any new vigorous activities after years of sedentary lifestyle, it is
recommended to obtain an ETT to rule out underlying CAD.)
A smoker of 3 weeks
A member of congress
Developmentally challenged
Question 10:
What is the leading cause of death for women in the United States?
xHeart disease (Heart disease is the leading cause of death for women in the United States.)
Breast cancer
Lung cancer
Complications of childbirth
Question 11:
In women, you need to know the limitations of certain tests for CAD. For example, single-photon
emissions CT imaging, while an acceptable test for most men and some women, is technically limited in
women for two reasons. From the following, choose the best possible answer.
Smoking rates and lack of uptake of photons
Multiple vessel disease and fat deposits
Breasts and fat deposits in abdomen
, xBreasts and smaller coronary arteries (Single-photon emissions CT imaging is technically limited in
women due to breasts and smaller coronary arteries.)
Question 12. Question :
What are two of the most common forms of Exercise Stress Tests used today?
Unicycle and Running in pace
Thallium and Dobutamine
Bicycle and rowing machine
xBicycle and treadmill (Bicycle and treadmill are the two most common forms of exercise stress tests
used today. )
Question 13. Question :
Improvements in the delivery and management of healthcare are necessary if we are to improve the
overall health of this nation’s population. Which of the following are identified in your readings as
strategic in the movement to improve the healthcare system?
Socialized medicine and governmental controls
xPopulation management and healthcare practice (Population management and healthcare practice are
strategic in the movement to improve the nation’s healthcare system. )
Monetary savings and limited disruption in healthcare delivery
President and Congress
Question 14. Question :
For women with known CAD and diabetes, which is most appropriate to assess CAD risk?
ETT
xETT with imaging (ETT with imaging is most appropriate to assess CAD risk.)
Coronary catheterization
Coronary bypass surgery
Question 15. Question :
What is considered the first-line initial approach to test for CAD?
A 35 year old female arrives at your clinic. She has had diabetes and peripheral artery disease for the
past 5 years. You decide to obtain an ETT. The insurance company argues that this is inappropriate. You
justify the ETT because you are planning secondary strategies to prevent future heart disease. Where
could one find the supporting data for these guidelines?
Medicare guidelines
xFramingham risk score (These guidelines come from the Framingham risk score.)
Medicaid guidelines
Do not exist
Question 2.
You are counseling a patient diagnosed with stress-induced ischemia. You base your discussion on your
knowledge that stress-induced ischemia is thought to be caused by what phenomena?
Diet and exercise
Heart muscle dysfunction
Too many carbonated drinks
xEndothelial dysfunction of the microvascular (You base your discussion on your knowledge that stress-
induced ischemia is thought to be caused by endothelial dysfunction of the microvascular.)
Question 3.
What happens to coronary flow related to CAD?
Hyper profusion of the myocardium
Cerebral vascular infarction
xHypo profusion of the myocardium (Because of the restrictive flow of blook through the coronary
arteries, hypo profusion of the myocardium results from coronary flow related to CAD which causes the
presenting symptoms)
Functional systolic pressures
Question 4:
A 47-year old female with general complaints of fatigue and shortness of breath shows up in your clinic
as a referral from another nurse practitioner. Several blood tests and chest x-rays have been completed
without any diagnosis or outstanding abnormalities. You decide to order an ETT despite the fact that the
recent ECG does not show any abnormalities. From the answers below, which would be the best answer
to support your decision?
You are out of other options
,Women present with the same pattern of CAD as do males
xCAD in women is under diagnosed (You make this choice because you are aware that CAD in women is
under diagnosed.)
To please the patient
Question 5:
You are in the clinic with your mentor observing the Echocardiogram exercise test of a 45-year old male
that has been experiencing slight chest pressure almost daily during exercise. While observing your
patient, your mentor points out that the left ventricle wall is thinning and there is some hyperkinesias of
the ventricular wall. From your time in the clinic, you know that this test will be considered to be what
type of result?
Impossible
Negative
xPositive (From your time in the clinic, you know because of wall thinning and hyperkinesis that this test
will be considered to be positive.)
Non-readable
Question 6:
On the echocardiography during the ETT you notice the following change: abnormal left ventricular
ejection fraction. What do these changes suggest related to this patient?
Non-ischemic changes of the baseline ECG
xIschemia of the myocardium (Abnormal left ventricular ejection fraction suggests ischemia of the
myocardium.)
Rise in heart rate without evidence of ischemia
Weak ventricular muscles
Question 7:
Population disease management is a term used to describe:
High specificity disease states
Low specificity diseases states
Low prevalence specific diseases
xHigh prevalence specific diseases (Population disease management is a term used to describe the high
prevalence of specific diseases.)
Question 8:
Why would inability to exercise reduce the specificity of the routine ETT?
,Causes ST-segment changes and P-wave abnormalities
Will not produce any changes in ECG
xProduces persistent ST-segmental changes and T-wave abnormalities (The inability to exercise reduces
the specificity of the routine ETT because it produces persistent ST-segmental changes and T-wave
abnormalities.)
Produces QRS changes that cannot be interpreted
Question 9:
All patients, even if asymptomatic, require risk stratification according to the Farmingham risk score. At
present, ACC/AHA guidelines, however, do not normally support stress tests for asymptomatic patients
without additional justification. From the list below, what could be used to justify an ETT in an
asymptomatic patient?
xSedentary and wishes to begin aggressive exercise (Many patients have underlying CAD but remain
asymptomatic. Before beginning any new vigorous activities after years of sedentary lifestyle, it is
recommended to obtain an ETT to rule out underlying CAD.)
A smoker of 3 weeks
A member of congress
Developmentally challenged
Question 10:
What is the leading cause of death for women in the United States?
xHeart disease (Heart disease is the leading cause of death for women in the United States.)
Breast cancer
Lung cancer
Complications of childbirth
Question 11:
In women, you need to know the limitations of certain tests for CAD. For example, single-photon
emissions CT imaging, while an acceptable test for most men and some women, is technically limited in
women for two reasons. From the following, choose the best possible answer.
Smoking rates and lack of uptake of photons
Multiple vessel disease and fat deposits
Breasts and fat deposits in abdomen
, xBreasts and smaller coronary arteries (Single-photon emissions CT imaging is technically limited in
women due to breasts and smaller coronary arteries.)
Question 12. Question :
What are two of the most common forms of Exercise Stress Tests used today?
Unicycle and Running in pace
Thallium and Dobutamine
Bicycle and rowing machine
xBicycle and treadmill (Bicycle and treadmill are the two most common forms of exercise stress tests
used today. )
Question 13. Question :
Improvements in the delivery and management of healthcare are necessary if we are to improve the
overall health of this nation’s population. Which of the following are identified in your readings as
strategic in the movement to improve the healthcare system?
Socialized medicine and governmental controls
xPopulation management and healthcare practice (Population management and healthcare practice are
strategic in the movement to improve the nation’s healthcare system. )
Monetary savings and limited disruption in healthcare delivery
President and Congress
Question 14. Question :
For women with known CAD and diabetes, which is most appropriate to assess CAD risk?
ETT
xETT with imaging (ETT with imaging is most appropriate to assess CAD risk.)
Coronary catheterization
Coronary bypass surgery
Question 15. Question :
What is considered the first-line initial approach to test for CAD?
