NRNP 6540 Case Study 1: CC: Mrs. L.,(answered) complete guide, to help you ace on your study (latest summer 2020/2021).

NRNP 6540 Case Study 1: CC: Mrs. L.,(answered) complete guide, to help you ace on your study (latest summer 2020/2021). I. CARDIOVASCULAR 1. A 74-year-old man presents to your office for a routine He has no present complaint His medical history is significant for right knee osteoarthritis He takes naproxen occasionally, to relieve knee pain. He does not smoke or consume alcohol His BP is 165/75 mm Hg and PR is 70/min. The physical examination showed a mild systolic ejection type murmur at the base of the heat to the right. An EKG revealed left ventricular hypertrophy and secondary ST segment and T wave change Moderate left ventricular hypertrophy, without any flow abnormalities, was demonstrated on echocardiography. The ejection fraction was 60%. What is the most probable cause of hypertension in this patient? A. Rigidity of the arterial wall B. Elevated plasma renin activity C. Aortic insufficiency D. Increased cardiac output E. Increased intravascular volume 2. A 32-year-old Caucasian female comes to the physician because of a one-week history of fatigue, progressive worsening of shortness of breath and swelling of feet. She denies any chest pain She has no other medical problems except a recent cold two weeks ago. She is not taking any medication Her temperature is 36 7 C (98 F), blood pressure is 110/65 mmHg, pulse is g0/min, and respirations are 20/min Bilateral basal crackles, elevated jugular venous pressure, and 2+ bilateral pitting edema of the ankles are noted Complete blood count is unremarkable. Transthoracic echocardiogram of her heat will most likely show? A. Concentric hypertrophy of the heart B. Eccentric hypertrophy of the heart C. Mitral stenosis D. Hypokinesia of the inferior wall E. Dilated ventricles with diffuse hypokinesia 3. A 47-year-old woman loses consciousness for 2 minutes while shopping in a supermarket. In the emergency room, she recounts feeling nausea and warmth spreading over her body immediately before passing out She has never had a similar episode before. She has not seen a doctor for several years and does not take any medications, nor does she use tobacco, alcohol or drug. Her family history is unremarkable. Which of the following most likely caused this episode? A. Cardiac arrythmia B. Seizure C. Neurocardiogenic syncope D. Heat valve disease E. Orthostatic hypotension 4. A 25-year-old woman experiences sudden-onset palpitations and generalized weakness. During this episode, her blood pressure is 100/60 mmHg and her heat rate is 160/min and regular. She has no significant past medical history and does not take any medications She reports having a few similar episodes in the past which she has self-treated by immersing her face in cold water Generally, she says, cold water immersion relieves her symptoms within several minutes. This cold water therapy works by affecting which of the following? A. Vascular tone B. Sinoatrial node automatism C. Atrioventricular node conductivity D. Purkinje fiber conduction E. Ventricular myocardium contractility 5. A 67-year-old man is evaluated for hypertension He complains of occasional morning headaches. His past medical history is also significant for type 2 diabetes mellitus, coronary artery disease, and a stroke with residual left-sided weakness. He underwent coronary artery bypass surgery seven years ago and carotid endarterectomy five years ago. His current medication list includes lisinopril hydrochlorothiazide, amlodipine, metoprolol, aspirin, metformin and glyburide His blood pressure is 190/120 mmHg on the right arm and 170/110 mmHg on the left arm. His heat rate is 65/min Physical examination reveals a periumbilical systolic-diastolic bruit. The latter finding is best explained by which of the following? A. Abdominal aortic aneurysm B. Aortic dissection C. Aortic coarctation D. Renal artery stenosis E. Aorto-enteric fistula 6. A 67-year-old male is brought to the emergency department after a syncopal episode. He lost consciousness while shopping in the mall. He denies any nausea, diaphoresis, chest pain, or shortness of breath. He has had two episodes of lightheadedness over the last month but has not seen a doctor. His past medical history is significant for long-standing hypertension, which is being treated with enalapril. His blood pressure is 135/90 mmHg while supine, and 130/85 mmHg while standing His heat rate is 64/min ECG shows a sinus rhythm with high voltage, prolonged PR interval, prolonged QRS interval, normal QT interval and occasional premature ventricular contractions (PVC) E- chocardiography reveals left ventricular hypertrophy and an ejection fraction (EF) of 55% Which of the following is the most likely cause of this patient's syncope? A. Bradyarrhythmia B. Decreased myocardial contractility C. Torsades de pointes D. Autonomic dysfunction E. Ventricular premature beats 7. A 60-year-old male is 2 days status post primary percutaneous coronary intervention (PCI) with stent placement. He had previously suffered from an antero-lateral myocardial infarction. His cardiac enzymes have been trending down since admission He has recovered well and is ready for discharge He is currently asymptomatic. His temperature is 37.5 C (99.5 F), blood pressure is 130/70 mm Hg, pulse is 66/min, and respirations are 14/min He is discharged with instructions to take the following medications aspirin simvastatin, lisinopril metoprolol and sublingual nitroglycerine. In addition to the medications listed above, which of the following medications should this patient also be taking after discharge? A. Isosorbide mononitrate B. Low molecular weight heparin C. Waffarin D. Clopidogrel E. Amlodipine 8. A 47-year-old male presents to your office with a two-month history of lethargy and decreased libido His medical records reveal that he has been treated for joint pain and swelling over the last six months and was diagnosed with diabetes mellitus one year ago Physical examination reveals hepatomegaly and testicular atrophy Which of the following cardiac abnormalities is most likely to also be present in this patient? A. Atrial septal defect B. Aortic stenosis C. Hypertrophic cardiomyopathy D. Cardiac conduction block E. Endocardial fibroelastosis 9. A 35-year-old Caucasian male is being evaluated for poor exercise tolerance and muscle weakness He has no past medical history His blood pressure ranges from 175-185 mmHg systolic and 105-1 15 mmHg diastolic on repeat measurement His heat rate is 78-g5/min His serum chemistry is significant for blood glucose of 95 mg/dL serum creatinine of 0.7mg/dL serum Na of 146 mEq/L and serum K of 2.4 mEq/l_ CT scan of the abdomen reveals a 3 cm mass in the left adrenal gland. Which of the following additional findings would you expect in this patient? Plasma renin activity, Serum aldosterone, Serum bicarbonate A High High Low B High High High C low High High D low High Low E High Low High 10. A 67-year-old homeless male presents 24 hours after the onset of substernal chest pain and is diagnosed with an anterior wall myocardial infarction. There is no history of previous chest pain, dyspnea, palpitations, syncope or leg swelling. He has no hypertension or diabetes mellitus. He does acknowledge a 40 pack-year smoking history. Upon discharge, echocardiography shows normal left ventricular size, left ventricular anterior wall hypokinesis and an ejection fraction of 50%. Two years later, the patient is found dead in the street. Autopsy reveals a dilated left ventricle with a globular shape and thinned walls along with a scar on the anterior wall. Which of the following would have most likely prevented this patient's pathologic findings? A.Aspirin B. Enalapril C. Amlodipine D.Isosorbide dinitrate E. Digoxin 11. A 50-year-old woman presents to your office complaining of lower extremity edema that stated several weeks ago, and slowly progressed thereafter. Her past medical history is significant for hypertension, treated with metoprolol for 2 years. Amlodipine was added recently because of inadequate control of BP with metoprolol alone. She does not smoke or consume alcohol. She has no known drug allergies. Her blood pressure is 130/80mm Hg and her heart rate is 64/min. The physical examination reveals bilateral symmetric 3+ pitting edema of both lower extremities, without any skin changes or varicosities Her neck vein pulsation is normal. Other physical findings are within normal limits. Her laboratory studies reveal the following: Serum albumin 4.5 g/dL Total serum bilirubin 0.8 mg/dL Serum sodium 140 mEq/L Serum potassium 4.0 mEq/L Serum creatinine 0.8 mg/dL Urinalysis is within normal limite. What is the most likely cause of the edema in this patient? A.Heart failure B. Liver disease C. Renal disease D. Venous insufficiency E. Side effect of her medications 12. A 64-year-old male who has not seen a doctor for the past 20 years presents to the emergency room with excruciating chest pain that stated suddenly about three hours ago. He describes the pain as tearing in quality and says that it radiates to his back. On physical examination, you hear an early diastolic decrescendo murmur at the sternal border. Chest x ray shows widening of the superior mediastinum. EKG is normal. Which of the following medical conditions most likely accounts for this patients presentation? A. Systemic hypertension B. Marfan's syndrome C. Ehlers-Darlos syndrome D. Bicuspid aortic valve E. Giant cell arteritis 13. A 40-year-old female presents to the emergency room with palpitations and lightheadedness of acute onset. Also, she has experienced insomnia, fatigability, and weight loss lately. She does not smoke or consume alcohol. She is not taking any medication. Her blood pressure is 110/80 mmHg and heat rate is 120/min, irregular. Physical examination reveals lid lag and fine tremor of the outstretched hands. ECG shows atrial fibrillation with rapid ventricular response. What is the next best step in the management of this patient? A. Digoxin B. Propranolol C. Lidocaine D. Quinidine E. Immediate cardioversion 14. A 43-year-old Caucasian man with a two-year history of diabetes mellitus presents to your office for a routine. He has no complaint His medications are metformin and aspirin. He works as a computer programmer and has a sedentary lifestyle. He drinks one to two cans of beer on weekends and smokes one pack of cigarettes per day. On physical examination, his blood pressure is 153/94 mm Hg and his heat rate is 82/min His BMI is 32.5 kg/m2. The remainder of the physical examination is unremarkable Laboratory studies reveal an HbA1c of 7.6%. At his check-up one month ago, his blood pressure was 149/92 mmHg. Which of the following interventions would be most effective for controlling his blood pressure? A. Aerobic exercise B. Weight loss C. Smoking cessation D. Better diabetes control E. Quitting alcohol.