Clinical Management Exam 4
Organic nitrates provide relief of angina pectoris symptoms via:
increasing preload and myocardial oxygen consumption and extraction
increasing myocardial contractility and venous capacitance
decreasing coronary vasoconstriction and venous return
relaxation of smooth muscle and increased contractility of the myocardium - decreasing coronary
vasoconstriction and venous return
The NP is evaluating a 55 y/o female with a 25 yr. history of type 2 DM for complaints of progressive
shortness of breath and occasional chest pain with exertion. This has been happening occasionally for
the past two months. Physical exam reveals an obese patient in no acute distress. Heart rate is 82/min,
BP 188/91 mm Hg. Jugular venous pressure is elevated and bibasilar crackles are noted. Cardiac
examination reveals a regular rhythm, normal S1 and S2, and the presence of an S3. There is peripheral
edema. An ECG reveals evidence of a prior myocardial infarction. The echocardiogram is notable for
severely decreased systolic function (left ventricular ejection fraction, 25%). Which of the following is
the most appropriate next diagnostic test?
cardiac catheterization
,exercise stress test
endomyocardial biopsy
measurement of B-type natriuretic peptide - cardiac catheterization
Which of the following patients is not in one of the four statin benefit groups?
Joe, a 42y/o male with hypertension, no evidence of ASCVD, a LDL 120mg/dl, and an estimated ASCVD
risk of 5%
Mary, a 54y/o patient with diabetes and no evidence of ASCVD, who walks 5 miles a day and has a LDL
78mg/dl
Anthony, a 60y/o patient who has a history of myocardial infarction
Maria, a 72y/o patient with no evidence of ASCVD a LDL 220mg/dl
, a & b - Joe, a 42y/o male with hypertension, no evidence of ASCVD, a LDL 120mg/dl, and an estimated
ASCVD risk of 5%
Daniel is a 58 year old patient who presents with complaints consistent with what is best termed
"atypical" chest pain symptoms. The NP understand that:
atypical chest pain is not reproducible with movement or palpation
atypical chest pain and a negative ECG safely excludes the diagnosis of acute coronary syndrome
atypical chest pain during myocardial ischemia is more likely to be reported by a female or diabetic
patient
atypical chest pain is typically precipitated by exertion
all of the above - atypical chest pain during myocardial ischemia is more likely to be reported by a
female or diabetic patient
According to the ACC/AHA guidelines, which of the following statement(s) is/are CORRECT regarding
prescribing statin therapy for hyperlipidemia?
baseline and routine monitoring of creatine kinase (CK) levels should be obtained on all patients
Organic nitrates provide relief of angina pectoris symptoms via:
increasing preload and myocardial oxygen consumption and extraction
increasing myocardial contractility and venous capacitance
decreasing coronary vasoconstriction and venous return
relaxation of smooth muscle and increased contractility of the myocardium - decreasing coronary
vasoconstriction and venous return
The NP is evaluating a 55 y/o female with a 25 yr. history of type 2 DM for complaints of progressive
shortness of breath and occasional chest pain with exertion. This has been happening occasionally for
the past two months. Physical exam reveals an obese patient in no acute distress. Heart rate is 82/min,
BP 188/91 mm Hg. Jugular venous pressure is elevated and bibasilar crackles are noted. Cardiac
examination reveals a regular rhythm, normal S1 and S2, and the presence of an S3. There is peripheral
edema. An ECG reveals evidence of a prior myocardial infarction. The echocardiogram is notable for
severely decreased systolic function (left ventricular ejection fraction, 25%). Which of the following is
the most appropriate next diagnostic test?
cardiac catheterization
,exercise stress test
endomyocardial biopsy
measurement of B-type natriuretic peptide - cardiac catheterization
Which of the following patients is not in one of the four statin benefit groups?
Joe, a 42y/o male with hypertension, no evidence of ASCVD, a LDL 120mg/dl, and an estimated ASCVD
risk of 5%
Mary, a 54y/o patient with diabetes and no evidence of ASCVD, who walks 5 miles a day and has a LDL
78mg/dl
Anthony, a 60y/o patient who has a history of myocardial infarction
Maria, a 72y/o patient with no evidence of ASCVD a LDL 220mg/dl
, a & b - Joe, a 42y/o male with hypertension, no evidence of ASCVD, a LDL 120mg/dl, and an estimated
ASCVD risk of 5%
Daniel is a 58 year old patient who presents with complaints consistent with what is best termed
"atypical" chest pain symptoms. The NP understand that:
atypical chest pain is not reproducible with movement or palpation
atypical chest pain and a negative ECG safely excludes the diagnosis of acute coronary syndrome
atypical chest pain during myocardial ischemia is more likely to be reported by a female or diabetic
patient
atypical chest pain is typically precipitated by exertion
all of the above - atypical chest pain during myocardial ischemia is more likely to be reported by a
female or diabetic patient
According to the ACC/AHA guidelines, which of the following statement(s) is/are CORRECT regarding
prescribing statin therapy for hyperlipidemia?
baseline and routine monitoring of creatine kinase (CK) levels should be obtained on all patients
