MSN-FNP Cardiovascular Exam Questions with Correct Answers

MSN-FNP Cardiovascular Exam Questions with Correct Answers Which of the following beta-blockers is cardio selective? A. Nadolol B. Propanolol C. Atenolol D. Penbutolol - 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. - 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. MSN-FNP Cardiovascular Exam Questions with Correct Answers 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 - 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 - 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 MSN-FNP Cardiovascular Exam Questions with Correct Answers 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 - 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. A 45 yo man's lipid profile results are sent to the NP. They are as follows: total cholesterol= 287; HDL= 30; LDL= 165. The NP interperts these results as: A. Abnormal; the elevated triglyceride levels is often the most concern. B. Borderline; this is considered to a borderline risk lipid profile. C. Abnormal; the total cholesterol and LDL levels are elevated and the HDL is too low. D. Normal; these results are of no concern; follow up with client in 1 year. - ANSWER C. Abnormal; the total cholesterol and LDL levels are elevated, and the HDL is too low. Explanation: Desired levels for lipid profile re total cholesterol 200, HDL 35, LDL 130, and triglycerides 150.