Apea FNP CARDIO Exam (Best Revision M
d d d d d d
aterial Updated April 2023) (Actual Exam Q
d d d d d d
uestions, Answers and Rationale)
d d d
AdcommondlabdfindingsdwithdACEdInhibitorsd--------dCorrectdAnswerd-------dIncreasedK+
ACEdinhibitord=
dretentiondofdpotassium.d
Measuredpotassiumdonedmonthdafterdstartingdanddonedmonthdafterdchangingdaddose
Whatdshoulddyouddo?d
PtdondMonoprildanddHCTZdfordhypertension.dHisdblooddpressuredisd160-170/92-
98dondseveraldblooddpressuredchecks
?dWoulddyoudadddandARB?d--------dCorrectdAnswerd-------
dIfdthesedaredatdmaximumddoses,dconsiderationdshoulddbedgivendtodaddingdadmedicationdfro
mdaddifferentdclass.d
CALCIUMdCHANNELdBLOCKERd
NOTdARBd-
dAddingdandARBdmaydresultdindadprecipitousddecreasedindhisdblooddpressuredbecausedhedta
kesdandACEdinhibitordanddbothdofdthesedmedicationsdworkdindthedrenin-angiotensin-
aldosteronedsystem.
Significancedofdsildenafildanddanydblooddpressuredmedsd--------dCorrectdAnswerd-------
dAnydantihypertensivedmedicationd...dcoulddhavedandadditivedeffectdwithdsildenafild(ordanoth
erdmedicationdindthisd
Adspecificddrug-
drugdinteractiondtodbedawaredofdisdthedonedthatdcandoccurdwithdsildenafildanddalphadblockers
dlikedtamsulosin,dalfuzosin,dprazosin,ddoxazosin,dordterazosin.dThisdcombinationdofdmedica
tionsdmaydincreasedthedriskdofdsymptomaticdhypotensiondbecausedthedeffectdofdthesedtwodd
rugsdisdadditive
--------dCorrectdAnswerd-------dConsiderdtwodmedsd
d
lowddosedHCTZdanddARBdordaced
Thisdpatient'sdblooddpressuredgoaldisd<d140/90daccordingdtodJNCdVIII.dSincedhedisdmoredtha
nd20dpointsdabovedsystolicdgoald(ordgreaterdthand10dpointsdaboveddiastolicdgoal)ditdisdreason
abledtodconsiderdtwodmedications
Riskdassessmentdforddyslipidemia-dwhatdagedtodstartdassessmentd--------dCorrectdAnswerd--
-----dStartdatdaged2
,DyslipidemiadassessmentddoesdnotdnecessarilydmeandadDyslipidemiadassessmentdrefersdt
odassessingdfamilydhistorydofddyslipidemia,dprematuredcardiovascularddisease,dorddiabetes
,dbodydmassdindexd>d85%dfordagedanddsex,dordhistorydofdotherdsystemicddiseasesdlikedKawa
sakidDiseasedordtreatment,dordrenalddisease.
Whendtodstartdlipiddprofilesd--------dCorrectdAnswerd-------
drecommendeddbetweend18dandd21dyearsdofdage.
AdpatientdtakingdandACEdinhibitordshoulddavoid:d--------dCorrectdAnswerd-------
dNodKdsupplementsd
ACEdinhibitordpotentiallydcandproducedhyperkalemiadbecauseditsdmechanismdofdactiondisdin
dthedrenin-angiotensin-
aldosteronedsystemdwheredpotassiumdisdspared.dIfdpotassiumdisdtakendindthedformdofdpotas
siumdsupplements,dthedeffectdwilldbedadditivedanddthedriskdofdhyperkalemiadcandbedgreat.
And80dyear-
olddfemaledwhodisdotherwisedwell,dhasdadblooddpressuredofd176/80.dHowdshoulddshedbedma
nageddpharmacologically?d--------dCorrectdAnswerd-------dCCB
Thisdpatientdhasdisolateddsystolicdhypertensiond(ISH).dThisdisdcommondindolderdadultsdanddi
sdassociateddwithdtragicdcardiacdanddcerebrovasculardevents.dTheddrugdclassdofdchoicedtodt
reatdthesedpatientsdisdadlong-
actingdcalciumdchanneldblocker.dThedclassdofdcalciumdchanneldblockersdrecommendeddford
ISHdhasdthedsuffixd"pine"d(amlodipine,dfelodipine,detc).
Rememberd
ISHd=dPINE
ACEdinhibitordisdspecificallydindicateddindpatientsdwhodhaved...d--------dCorrectdAnswerd-------
dhypertension,ddiabetesdwithdproteinuria,dheartdfailure.
77dyear-
olddpatientdhasdhaddandincreasedindblooddpressuredsincedthedlastdexam.dThedblooddpressur
edhasdrisendtod168/88dwithd2dreadings.dThedlastdexam'sdreadingdwasd144/90.dIfdmedicationdi
sdtodbedstarteddondthisdpatient,dwhatdwoulddbedadgooddfirstdchoice?d--------dCorrectdAnswerd-
------dCCB
Thisdpatientdisd77dyearsdolddanddshoulddhavedadgoaldblooddpressuredofd<d150/90.dAdthiazide
ddiureticdisdnotdadgooddfirstdchoicedindthisdpatientdbecauseditdwilldnotdbedpotentdenoughdtodde
creasedblooddpressuredbyd25dpointsdtodgetdhimdtodgoal.dAdlongdactingdcalciumdchanneldbloc
kerdisdappropriatedfordpatientsdwithdisolateddsystolicdhypertensiondanddwilldbedmoredlikelydto
dgetdthisdpatientdtodgoaldpressuredthandHCTZ.dBeta-
blockersdarednodlongerdrecommendeddfirstdlinedforduncomplicateddhypertension.dACEdinhib
itorsdaredverydeffectivedindpatientsdwhodaredhighdrenindproducers.dElderlydpatientsdtenddtodp
roducedlowerdamountsdofdrenin.
, Ad63dyear-
olddmaledhasdbeendyourdpatientdfordseveraldyears.dHedisdadformerdsmokerdwhodtakesdsimva
statin,dramipril,danddandaspirinddaily.dHisdblooddpressuredanddlipidsdaredwelldcontrolled.dHed
presentsdtodyourdclinicdwithdcomplaintsdofdfatiguedandd"justdnotdfeelingdwell"dfordthedlastdfewd
days.dHisdvitaldsignsdanddexamdarednormal.dWhatdshoulddbeddonednext?d
OrderdadCBCdanddconsiderdwaitingdadfewddaysdifdnormal.d
Inquiredaboutdfeelingsdofddepressiondanddhopelessness.d
OrderdadCBC,dmetabolicdpanel,dTSH,danddurinedanalysis.d
OrderdadB12dlevel,dTSH,dCBC,danddchestdx-rayd--------dCorrectdAnswerd-------
dOrderdCBC,dBMP,dTSH,du/a
Fatiguedisdaddifficultdcomplaintdtodassessdandddiagnose.dThisdpatient'sdexamdanddvitaldsign
sdarednormal.dTheredisdnodreasondtodthinkdthatdhedisdinfecteddordisdbleeding,dsodadlonedCBC,d
offersdlittleddiagnosticdhelp.dHowever,dindadditiondtodadCBC,daddingdadmetabolicdpanel,dTS
H,danddurined(todscreendfordblooddindthisdformerdsmoker)disdadmoredthoroughdlaboratorydass
essmentdofdhisdfatigue.
Adpatientdwithdshortnessdofdbreathdhasdsuspecteddheartdfailure.dWhatddiagnosticdtestdwould
dbestdhelpddeterminedthis?d
Echocardiogramd
Bdtypednatriureticdpeptided(BNP)d
EKGd
Chestdx-rayd--------dCorrectdAnswerd-------dBNPdCHEAPERd
BNPdisdadhormonedinvolveddindregulationdofdblooddpressuredanddfluiddvolume.dWhendthedB
NPdleveldisd80dpg/mLdordgreater,dthedsensitivitydanddspecificitydisd98%dandd92%,dfavoringdad
diagnosisdofdheartdfailure.dAlternatively,dBNPdlevelsdlessdthand80dpg/mLdstronglydsuggestdt
hatdheartdfailuredisdnotdpresentd(SomedUSdinstitutionsdused100dpg/mL).dOtherdconditionsdm
aydcausedelevateddBNPdlevels:dthoracicdanddabdominaldsurgery,drenaldfailure,danddsubara
chnoiddhemorrhage.dConsequently,dcarefuldassessmentdofdthedpatientdisdprudent.dEchocar
diogramsdmechanicallydevaluatedthedheartdanddestablishdandejectiondfraction.dIfd<35-
40%,dthendHFdcandusuallydbeddiagnosed.dEjectiondfractionsddodnotdalwaysdcorrelatedwithdp
atientdsymptoms.dEKGdevaluatesdthedelectricaldactivitydofdthedheart.dChestdx-
raydcandindicatedheartdfailuredbutdadBNPdisdadmoredsensitivedmeasure.
And80dyear-
olddpatientdwithdlongdstandingdhypertensiondtakesdMonoprildanddHCTZdfordhypertension.dHi
sdblooddpressuredisd160-170/92-
98dondseveraldblooddpressuredchecks.dWhatdshoulddbeddonedaboutdhisdblooddpressure?d
Adddandangiotensindreceptordblockerd(ARB)d
Adddanotherddiureticd
d d d d d d
aterial Updated April 2023) (Actual Exam Q
d d d d d d
uestions, Answers and Rationale)
d d d
AdcommondlabdfindingsdwithdACEdInhibitorsd--------dCorrectdAnswerd-------dIncreasedK+
ACEdinhibitord=
dretentiondofdpotassium.d
Measuredpotassiumdonedmonthdafterdstartingdanddonedmonthdafterdchangingdaddose
Whatdshoulddyouddo?d
PtdondMonoprildanddHCTZdfordhypertension.dHisdblooddpressuredisd160-170/92-
98dondseveraldblooddpressuredchecks
?dWoulddyoudadddandARB?d--------dCorrectdAnswerd-------
dIfdthesedaredatdmaximumddoses,dconsiderationdshoulddbedgivendtodaddingdadmedicationdfro
mdaddifferentdclass.d
CALCIUMdCHANNELdBLOCKERd
NOTdARBd-
dAddingdandARBdmaydresultdindadprecipitousddecreasedindhisdblooddpressuredbecausedhedta
kesdandACEdinhibitordanddbothdofdthesedmedicationsdworkdindthedrenin-angiotensin-
aldosteronedsystem.
Significancedofdsildenafildanddanydblooddpressuredmedsd--------dCorrectdAnswerd-------
dAnydantihypertensivedmedicationd...dcoulddhavedandadditivedeffectdwithdsildenafild(ordanoth
erdmedicationdindthisd
Adspecificddrug-
drugdinteractiondtodbedawaredofdisdthedonedthatdcandoccurdwithdsildenafildanddalphadblockers
dlikedtamsulosin,dalfuzosin,dprazosin,ddoxazosin,dordterazosin.dThisdcombinationdofdmedica
tionsdmaydincreasedthedriskdofdsymptomaticdhypotensiondbecausedthedeffectdofdthesedtwodd
rugsdisdadditive
--------dCorrectdAnswerd-------dConsiderdtwodmedsd
d
lowddosedHCTZdanddARBdordaced
Thisdpatient'sdblooddpressuredgoaldisd<d140/90daccordingdtodJNCdVIII.dSincedhedisdmoredtha
nd20dpointsdabovedsystolicdgoald(ordgreaterdthand10dpointsdaboveddiastolicdgoal)ditdisdreason
abledtodconsiderdtwodmedications
Riskdassessmentdforddyslipidemia-dwhatdagedtodstartdassessmentd--------dCorrectdAnswerd--
-----dStartdatdaged2
,DyslipidemiadassessmentddoesdnotdnecessarilydmeandadDyslipidemiadassessmentdrefersdt
odassessingdfamilydhistorydofddyslipidemia,dprematuredcardiovascularddisease,dorddiabetes
,dbodydmassdindexd>d85%dfordagedanddsex,dordhistorydofdotherdsystemicddiseasesdlikedKawa
sakidDiseasedordtreatment,dordrenalddisease.
Whendtodstartdlipiddprofilesd--------dCorrectdAnswerd-------
drecommendeddbetweend18dandd21dyearsdofdage.
AdpatientdtakingdandACEdinhibitordshoulddavoid:d--------dCorrectdAnswerd-------
dNodKdsupplementsd
ACEdinhibitordpotentiallydcandproducedhyperkalemiadbecauseditsdmechanismdofdactiondisdin
dthedrenin-angiotensin-
aldosteronedsystemdwheredpotassiumdisdspared.dIfdpotassiumdisdtakendindthedformdofdpotas
siumdsupplements,dthedeffectdwilldbedadditivedanddthedriskdofdhyperkalemiadcandbedgreat.
And80dyear-
olddfemaledwhodisdotherwisedwell,dhasdadblooddpressuredofd176/80.dHowdshoulddshedbedma
nageddpharmacologically?d--------dCorrectdAnswerd-------dCCB
Thisdpatientdhasdisolateddsystolicdhypertensiond(ISH).dThisdisdcommondindolderdadultsdanddi
sdassociateddwithdtragicdcardiacdanddcerebrovasculardevents.dTheddrugdclassdofdchoicedtodt
reatdthesedpatientsdisdadlong-
actingdcalciumdchanneldblocker.dThedclassdofdcalciumdchanneldblockersdrecommendeddford
ISHdhasdthedsuffixd"pine"d(amlodipine,dfelodipine,detc).
Rememberd
ISHd=dPINE
ACEdinhibitordisdspecificallydindicateddindpatientsdwhodhaved...d--------dCorrectdAnswerd-------
dhypertension,ddiabetesdwithdproteinuria,dheartdfailure.
77dyear-
olddpatientdhasdhaddandincreasedindblooddpressuredsincedthedlastdexam.dThedblooddpressur
edhasdrisendtod168/88dwithd2dreadings.dThedlastdexam'sdreadingdwasd144/90.dIfdmedicationdi
sdtodbedstarteddondthisdpatient,dwhatdwoulddbedadgooddfirstdchoice?d--------dCorrectdAnswerd-
------dCCB
Thisdpatientdisd77dyearsdolddanddshoulddhavedadgoaldblooddpressuredofd<d150/90.dAdthiazide
ddiureticdisdnotdadgooddfirstdchoicedindthisdpatientdbecauseditdwilldnotdbedpotentdenoughdtodde
creasedblooddpressuredbyd25dpointsdtodgetdhimdtodgoal.dAdlongdactingdcalciumdchanneldbloc
kerdisdappropriatedfordpatientsdwithdisolateddsystolicdhypertensiondanddwilldbedmoredlikelydto
dgetdthisdpatientdtodgoaldpressuredthandHCTZ.dBeta-
blockersdarednodlongerdrecommendeddfirstdlinedforduncomplicateddhypertension.dACEdinhib
itorsdaredverydeffectivedindpatientsdwhodaredhighdrenindproducers.dElderlydpatientsdtenddtodp
roducedlowerdamountsdofdrenin.
, Ad63dyear-
olddmaledhasdbeendyourdpatientdfordseveraldyears.dHedisdadformerdsmokerdwhodtakesdsimva
statin,dramipril,danddandaspirinddaily.dHisdblooddpressuredanddlipidsdaredwelldcontrolled.dHed
presentsdtodyourdclinicdwithdcomplaintsdofdfatiguedandd"justdnotdfeelingdwell"dfordthedlastdfewd
days.dHisdvitaldsignsdanddexamdarednormal.dWhatdshoulddbeddonednext?d
OrderdadCBCdanddconsiderdwaitingdadfewddaysdifdnormal.d
Inquiredaboutdfeelingsdofddepressiondanddhopelessness.d
OrderdadCBC,dmetabolicdpanel,dTSH,danddurinedanalysis.d
OrderdadB12dlevel,dTSH,dCBC,danddchestdx-rayd--------dCorrectdAnswerd-------
dOrderdCBC,dBMP,dTSH,du/a
Fatiguedisdaddifficultdcomplaintdtodassessdandddiagnose.dThisdpatient'sdexamdanddvitaldsign
sdarednormal.dTheredisdnodreasondtodthinkdthatdhedisdinfecteddordisdbleeding,dsodadlonedCBC,d
offersdlittleddiagnosticdhelp.dHowever,dindadditiondtodadCBC,daddingdadmetabolicdpanel,dTS
H,danddurined(todscreendfordblooddindthisdformerdsmoker)disdadmoredthoroughdlaboratorydass
essmentdofdhisdfatigue.
Adpatientdwithdshortnessdofdbreathdhasdsuspecteddheartdfailure.dWhatddiagnosticdtestdwould
dbestdhelpddeterminedthis?d
Echocardiogramd
Bdtypednatriureticdpeptided(BNP)d
EKGd
Chestdx-rayd--------dCorrectdAnswerd-------dBNPdCHEAPERd
BNPdisdadhormonedinvolveddindregulationdofdblooddpressuredanddfluiddvolume.dWhendthedB
NPdleveldisd80dpg/mLdordgreater,dthedsensitivitydanddspecificitydisd98%dandd92%,dfavoringdad
diagnosisdofdheartdfailure.dAlternatively,dBNPdlevelsdlessdthand80dpg/mLdstronglydsuggestdt
hatdheartdfailuredisdnotdpresentd(SomedUSdinstitutionsdused100dpg/mL).dOtherdconditionsdm
aydcausedelevateddBNPdlevels:dthoracicdanddabdominaldsurgery,drenaldfailure,danddsubara
chnoiddhemorrhage.dConsequently,dcarefuldassessmentdofdthedpatientdisdprudent.dEchocar
diogramsdmechanicallydevaluatedthedheartdanddestablishdandejectiondfraction.dIfd<35-
40%,dthendHFdcandusuallydbeddiagnosed.dEjectiondfractionsddodnotdalwaysdcorrelatedwithdp
atientdsymptoms.dEKGdevaluatesdthedelectricaldactivitydofdthedheart.dChestdx-
raydcandindicatedheartdfailuredbutdadBNPdisdadmoredsensitivedmeasure.
And80dyear-
olddpatientdwithdlongdstandingdhypertensiondtakesdMonoprildanddHCTZdfordhypertension.dHi
sdblooddpressuredisd160-170/92-
98dondseveraldblooddpressuredchecks.dWhatdshoulddbeddonedaboutdhisdblooddpressure?d
Adddandangiotensindreceptordblockerd(ARB)d
Adddanotherddiureticd
