The patient is exhibiting Left upper lobe lingula
a productive cough and Ratonale: Lingular consolidation is described in
a low-grade fever. Chest this question precisely. If the cardiac
X-ray on PA view shows margin/silhouette is obliterated by the mass, the
a left lower chest area of lesion is either right middle lobe or left upper lobe
consolidation adjacent to lingula.
the left border of the
heart approximately 2 rib
spaces above the
costophrenic angle. The
lateral x-ray view shows
this lesion absent of the
window posterior to the
cardiac silhouette. Which
is the most likely location
of this area of focal
consolidation?
*Left upper lobe apex
*Right middle lobe
*Left upper lobe lingula
*Left lower lobe
The inability to fully relax Diastolic dysfunction
the myocardium during Rationale: The inability for the heart to relax is a
relaxation is a trademark trademark of the diagnosis of diastolic dysfunction
of which of the following and is common in patients with thickened
diagnoses? hypertrophic myocardium.
An otherwise healthy Calcium channel blocker
African American adult Rationale: African American patients per JNC8
male has been Hypertension Guidelines should be managed with
diagnosed with a dihydropyridine calcium channel blocker such as
hypertension. He has amlodipine (Norvasc) as first line management
been restricting his salt therapy for hypertension not at goal with DASH
intake, eating a DASH and lifestyle modifications.
(Dietary Approaches to
Stop Hypertension) diet,
and exercising more, but
his blood pressure is still
elevated. Which is the
,BEST medication to
prescribe him?
Your patient has been CT angiography of the chest
diagnosed with a 4.5cm Rationale: CT angiography is considered the
ascending aortic standard of care for measuring vascular luminal
aneurysm. Which dimensions with contrast. CT PE protocol is not
medical imaging is timed properly for the aorta (it's timed for the
considered standard of pulmonary artery). Although a plain film is able to
care for serial catch large aneurysms at times, they are not able
surveillance? to provide multi-axis reconstruction needed to
accurately measure the size. Transesophageal
echo is not needed to accurately measure the
aorta and requires the patient to undergo sedation
which is unnecessary.
Which of the following phenylephrine
medications does not Rationale: Phenylephrine only stimulates alpha 1
cause beta 1 receptors. The remaining three all have beta
stimulation? receptor activity.
A 50-year-old woman Congestive heart failure
with a history of Rationale: Of the available options, the most
hypertension presents accurate response is congestive heart failure as it
with dyspnea on exertion is signifying both a right ventricular back up with
and orthopnea. On jugular venous extension and crackles on lung
examination, she has assault, which are suggestive of left ventricular
jugular venous distention back up. it is possible the patient may have an
and bilateral crackles on acute myocardial infarction that precipitated this,
lung auscultation. What however, a patient has not described that, rather is
is the most likely only describing dyspnea on exertion and
diagnosis? orthopnea, which both speak to a state of fluid
overload. The only appropriate response of these
available is congestive heart failure.
Your patient with a Ordering a transthoracic echocardiogram and
history of HFrEF (heart order a Lifevest if EF is less than 35%
failure with reduced Rationale: The patient should have a protective
ejection fraction) with an mechanism such as an implantable automated
ejection fraction of 40% cardioverter defibrillator (AICD) or a Lifevest if the
who is also not on EF is less than 35% due to the increased risk of
optimal medical therapy sudden cardiac death with low EF states. Since
has been diagnosed with most patients are not eligible for 90 days for an
a myocardial infarction AICD in this state, optimizing their medication
this admission and regimen and repeating an echo in 2-3 months to
,received emergent re-evaluate for improvement in their EF is required
placement of a drug- by most insurance companies. A baseline echo is
eluting stent to the left needed at discharge to provide a baseline for
anterior descending improvement vs their repeat echo in 2-3 months.
artery. As the medical Dual anti-platelet therapy is required for 12 months
home who will manage minimum post-MI.
this patient after A Holter monitor does not provide any conceivable
discharge, which benefit for this patient as presented.
medication strategy
would you expect to be a
priority in the patient's
care?
Which of the following Caucasians
people groups represent Rationale: Statistically African Americans, Native
the least risk of cardiac Hawaiians, and American Indians are at at
disease? increased risk of cardiac disease due to higher
rates of hypertension, diabetes, and obesity than
Caucasians.
A 65-year-old woman a statin drug.
presents for a follow-up Rationale: Bile acid sequestrants and cholesterol
examination. She is a absorption inhibitors may be useful in reducing
smoker, and her ASVD risk, but for a patient who is an active
hypertension is now smoker with premature coronary disease history
adequately controlled (less than age 65 for women), has hypertension
with medication. Her and is far from an LDL goal, this patient is most
mother died at age 40 certainly a candidate for statin therapy, which
from a heart attack. The represents the most aggressive therapy option of
fasting lipid profile shows these four listed.
cholesterol = 240 mg/dL,
HDL = 30, and LDL =
200. In addition to
starting therapeutic
lifestyle changes, the
nurse practitioner should
start the patient on:
, Which of the following Peripheral neuropathy
end-organ sequelae is Ratioanle: Although patients with hypertension
not directly caused by frequently have peripheral neuropathy, it is only
uncontrolled directly attributed to patients who are also diabetic
hypertension? and is commonly found in non-hypertensive
diabetic patients. Proteinuria, AV nicking, and
hemorrhagic stroke are all caused by uncontrolled
hypertension.
Preventive cardiac care Genetic predisposition
should focus primarily on Rationale: Smoking cessation, exercise, and
addressing all the medication compliance all represent modifiable risk
following except? factors and should be the focus of preventive care.
Non-modifiable risk factors such as age, gender,
genetic/family history should not be the primary
focus of prevention.
A 33-year-old woman Oral contraceptives
presents with irregular Rationale: These are classic symptoms of
menstrual cycles, polycystic ovarian syndrome and the patient should
hirsutism, and obesity. be treated with oral contraceptives to help stabilize
Laboratory tests reveal their estrogen and progesterone. Additionally, they
elevated serum may be managed on metformin and/or
testosterone and LH spironolactone for their PCOS.
ratio > 2:1. What is the Oral contraceptive pills (OCPs) are often the first
most appropriate initial pharmacological treatment for polycystic ovary
treatment? syndrome (PCOS) because they help manage in
several ways:
Menstrual irregularities: OCPs can help regulate
menstrual cycles, making periods lighter and more
regular. This is important because irregular
ovulation can lead to endometrial hyperplasia,
which is a buildup of uterine tissue that can
increase the risk of uterine cancer.
Androgen excess: OCPs can reduce androgen
production and increase sex hormone-binding
globulin (SHBG), which binds androgens. This can
help reduce symptoms like acne, hirsutism
(unwanted body and facial hair), and androgenic
alopecia (male pattern baldness).
Endometrium protection: OCPs can protect the
endometrium by ensuring regular ovulation
a productive cough and Ratonale: Lingular consolidation is described in
a low-grade fever. Chest this question precisely. If the cardiac
X-ray on PA view shows margin/silhouette is obliterated by the mass, the
a left lower chest area of lesion is either right middle lobe or left upper lobe
consolidation adjacent to lingula.
the left border of the
heart approximately 2 rib
spaces above the
costophrenic angle. The
lateral x-ray view shows
this lesion absent of the
window posterior to the
cardiac silhouette. Which
is the most likely location
of this area of focal
consolidation?
*Left upper lobe apex
*Right middle lobe
*Left upper lobe lingula
*Left lower lobe
The inability to fully relax Diastolic dysfunction
the myocardium during Rationale: The inability for the heart to relax is a
relaxation is a trademark trademark of the diagnosis of diastolic dysfunction
of which of the following and is common in patients with thickened
diagnoses? hypertrophic myocardium.
An otherwise healthy Calcium channel blocker
African American adult Rationale: African American patients per JNC8
male has been Hypertension Guidelines should be managed with
diagnosed with a dihydropyridine calcium channel blocker such as
hypertension. He has amlodipine (Norvasc) as first line management
been restricting his salt therapy for hypertension not at goal with DASH
intake, eating a DASH and lifestyle modifications.
(Dietary Approaches to
Stop Hypertension) diet,
and exercising more, but
his blood pressure is still
elevated. Which is the
,BEST medication to
prescribe him?
Your patient has been CT angiography of the chest
diagnosed with a 4.5cm Rationale: CT angiography is considered the
ascending aortic standard of care for measuring vascular luminal
aneurysm. Which dimensions with contrast. CT PE protocol is not
medical imaging is timed properly for the aorta (it's timed for the
considered standard of pulmonary artery). Although a plain film is able to
care for serial catch large aneurysms at times, they are not able
surveillance? to provide multi-axis reconstruction needed to
accurately measure the size. Transesophageal
echo is not needed to accurately measure the
aorta and requires the patient to undergo sedation
which is unnecessary.
Which of the following phenylephrine
medications does not Rationale: Phenylephrine only stimulates alpha 1
cause beta 1 receptors. The remaining three all have beta
stimulation? receptor activity.
A 50-year-old woman Congestive heart failure
with a history of Rationale: Of the available options, the most
hypertension presents accurate response is congestive heart failure as it
with dyspnea on exertion is signifying both a right ventricular back up with
and orthopnea. On jugular venous extension and crackles on lung
examination, she has assault, which are suggestive of left ventricular
jugular venous distention back up. it is possible the patient may have an
and bilateral crackles on acute myocardial infarction that precipitated this,
lung auscultation. What however, a patient has not described that, rather is
is the most likely only describing dyspnea on exertion and
diagnosis? orthopnea, which both speak to a state of fluid
overload. The only appropriate response of these
available is congestive heart failure.
Your patient with a Ordering a transthoracic echocardiogram and
history of HFrEF (heart order a Lifevest if EF is less than 35%
failure with reduced Rationale: The patient should have a protective
ejection fraction) with an mechanism such as an implantable automated
ejection fraction of 40% cardioverter defibrillator (AICD) or a Lifevest if the
who is also not on EF is less than 35% due to the increased risk of
optimal medical therapy sudden cardiac death with low EF states. Since
has been diagnosed with most patients are not eligible for 90 days for an
a myocardial infarction AICD in this state, optimizing their medication
this admission and regimen and repeating an echo in 2-3 months to
,received emergent re-evaluate for improvement in their EF is required
placement of a drug- by most insurance companies. A baseline echo is
eluting stent to the left needed at discharge to provide a baseline for
anterior descending improvement vs their repeat echo in 2-3 months.
artery. As the medical Dual anti-platelet therapy is required for 12 months
home who will manage minimum post-MI.
this patient after A Holter monitor does not provide any conceivable
discharge, which benefit for this patient as presented.
medication strategy
would you expect to be a
priority in the patient's
care?
Which of the following Caucasians
people groups represent Rationale: Statistically African Americans, Native
the least risk of cardiac Hawaiians, and American Indians are at at
disease? increased risk of cardiac disease due to higher
rates of hypertension, diabetes, and obesity than
Caucasians.
A 65-year-old woman a statin drug.
presents for a follow-up Rationale: Bile acid sequestrants and cholesterol
examination. She is a absorption inhibitors may be useful in reducing
smoker, and her ASVD risk, but for a patient who is an active
hypertension is now smoker with premature coronary disease history
adequately controlled (less than age 65 for women), has hypertension
with medication. Her and is far from an LDL goal, this patient is most
mother died at age 40 certainly a candidate for statin therapy, which
from a heart attack. The represents the most aggressive therapy option of
fasting lipid profile shows these four listed.
cholesterol = 240 mg/dL,
HDL = 30, and LDL =
200. In addition to
starting therapeutic
lifestyle changes, the
nurse practitioner should
start the patient on:
, Which of the following Peripheral neuropathy
end-organ sequelae is Ratioanle: Although patients with hypertension
not directly caused by frequently have peripheral neuropathy, it is only
uncontrolled directly attributed to patients who are also diabetic
hypertension? and is commonly found in non-hypertensive
diabetic patients. Proteinuria, AV nicking, and
hemorrhagic stroke are all caused by uncontrolled
hypertension.
Preventive cardiac care Genetic predisposition
should focus primarily on Rationale: Smoking cessation, exercise, and
addressing all the medication compliance all represent modifiable risk
following except? factors and should be the focus of preventive care.
Non-modifiable risk factors such as age, gender,
genetic/family history should not be the primary
focus of prevention.
A 33-year-old woman Oral contraceptives
presents with irregular Rationale: These are classic symptoms of
menstrual cycles, polycystic ovarian syndrome and the patient should
hirsutism, and obesity. be treated with oral contraceptives to help stabilize
Laboratory tests reveal their estrogen and progesterone. Additionally, they
elevated serum may be managed on metformin and/or
testosterone and LH spironolactone for their PCOS.
ratio > 2:1. What is the Oral contraceptive pills (OCPs) are often the first
most appropriate initial pharmacological treatment for polycystic ovary
treatment? syndrome (PCOS) because they help manage in
several ways:
Menstrual irregularities: OCPs can help regulate
menstrual cycles, making periods lighter and more
regular. This is important because irregular
ovulation can lead to endometrial hyperplasia,
which is a buildup of uterine tissue that can
increase the risk of uterine cancer.
Androgen excess: OCPs can reduce androgen
production and increase sex hormone-binding
globulin (SHBG), which binds androgens. This can
help reduce symptoms like acne, hirsutism
(unwanted body and facial hair), and androgenic
alopecia (male pattern baldness).
Endometrium protection: OCPs can protect the
endometrium by ensuring regular ovulation
