Week 3 Full Length Practice Exam
Attempt History
Attempt Time Score
LATEST Attempt 1 180 minutes 122 out of 150
Score for this quiz: 122 out of 150
Submitted Jan 26 at 2:45pm
This attempt took 180 minutes.
Question 1
pts
An older adult with diabetes mellitus presents with leg cramps. She states that the
cramps as worst when walking to the supermarket. If she stops to rest, the pain subsides.
The nurse practitioner knows that this patient needs a workup for:
Popliteal aneurism
Intermittent claudication
Deep vein thrombosis
Benign nocturnal leg cramps
Question 2
pts
Your patient presents with bradycardia, severe nausea, and substernal pain. STEMI was
identified on the EKG. Which region of the heart is most likely involved?
Correct!
Inferior Wall
The inferior wall, fed by the right coronary artery is commonly associated with these symptoms.
Remember right equals rate as it is the blood supply for the SA and AV nodes in most patients.
Dyspepsia is common in RCA territory injury due to vagal stimulation not typical of other areas.
,Question 3
pts
Recommendation for lipid check in adolescent with type 1 DM?
Correct!
1 year
Remember than with pediatric patients with diabetes, the easiest way to remember the
evaluation schedule is to perform lipid checks is with annual physicals.
Question 4
pts
An 80-year-old man with a history of atrial fibrillation presents with sudden-onset
unilateral leg pain and pallor. What is the most likely diagnosis?
Deep vein thrombosisect!
Acute arterial occlusion
Cellulitis
Peripheral artery disease
Question 5
pts
An adult patient recently placed on angiotensin-converting enzyme (ACE) inhibitor for
hypertension returns with a report of a dry, persistent cough. On examination, no
indication of a respiratory problem is noted. Which of the following is the most
appropriate intervention?
Correct!
Switch to an angiotensin II receptor blocker
Obtain a chest X-ray with posterior-anterior and lateral views
Continue the ACE inhibitor and prescribe a mild antitussive
,Continue the current treatment regimen
Question 6
pts
A 65 year old alcoholic patient presents with a new onset of persistent palpitations and
anxiety for the past 3 days. Your monitor is applied and an irregularly irregular rhythm is
noted. Which of the following evaluations should be performed first in your treatment?
Ordering a BNP and Vitamin D level
Prescribing amiodarone 150mg IV bolus
Correct!
Ordering a transthoracic echocardiogram
After 48-72 hrs of atrial fibrillation, the presence of thrombus must be excluded before any
rhythm-modifying intervention. Transthoracic echo is the gold standard for a quick look for any
clot burden, most likely found in the left atrial appendage. Amiodarone is likely to convert the
patient to a sinus rhythm and needs to be done only after determining no evidence of thrombus
is present. BNP and vitamin D are inconsequential in the treatment of A-fib (TSH, serum K, and
magnesium would be valuable). Bilateral radial pulse checks are not assessed for a-fib, but rather
for patients with concern for aortic dissection and/or vascular blockage (subclavian stenosis,
thoracic outlet syndrome, etc)
Palpating pulses bilaterally to identify unilateral pulse deficit
Question 7
pts
A 70-year-old man with a history of atrial fibrillation presents with sudden-onset left-
sided weakness and slurred speech. What is the most likely diagnosis?
Seizure
Transient ischemic attack (TIA)
, Myocardial infarction (MI)
Correct!
Stroke
The patient with a history of atrial fibrillation for over 48 hours without anticoagulation
is at risk of an embolic stroke, secondary to mobilization of a thrombus (90% of which
occur in the left atrial appendage). A patient exhibiting signs of a stroke such as unilateral
weakness and slurred speech, in addition to being evaluated for stroke with cranial
imaging to rule out a hemorrhagic etiology, should also be evaluated for a cardiac
etiology as noted above with an echocardiogram.
Question 8
pts
What is the key long-term benefit of using carvedilol for patients with coronary artery
disease and heart failure with reduced ejection fraction (HFrEF)?
Reduction in cardiac output
Increase in libido
Baseline reduction of blood pressure
Correct!
Potential increase in ejection fraction
EF increase is a key reason for using carvedilol over metoprolol for patients with low EF states.
Libido unfortunately can be negatively impacted by any beta blocker. Cardiac output should only
improve with long term use, not decrease, and beta blockers may reduce blood pressure slightly,
but that is not their key long-term benefit. In fact, they are not even considered for routine anti-
hypertensive management per JNC-8 guidelines.
Question 9
pts
Attempt History
Attempt Time Score
LATEST Attempt 1 180 minutes 122 out of 150
Score for this quiz: 122 out of 150
Submitted Jan 26 at 2:45pm
This attempt took 180 minutes.
Question 1
pts
An older adult with diabetes mellitus presents with leg cramps. She states that the
cramps as worst when walking to the supermarket. If she stops to rest, the pain subsides.
The nurse practitioner knows that this patient needs a workup for:
Popliteal aneurism
Intermittent claudication
Deep vein thrombosis
Benign nocturnal leg cramps
Question 2
pts
Your patient presents with bradycardia, severe nausea, and substernal pain. STEMI was
identified on the EKG. Which region of the heart is most likely involved?
Correct!
Inferior Wall
The inferior wall, fed by the right coronary artery is commonly associated with these symptoms.
Remember right equals rate as it is the blood supply for the SA and AV nodes in most patients.
Dyspepsia is common in RCA territory injury due to vagal stimulation not typical of other areas.
,Question 3
pts
Recommendation for lipid check in adolescent with type 1 DM?
Correct!
1 year
Remember than with pediatric patients with diabetes, the easiest way to remember the
evaluation schedule is to perform lipid checks is with annual physicals.
Question 4
pts
An 80-year-old man with a history of atrial fibrillation presents with sudden-onset
unilateral leg pain and pallor. What is the most likely diagnosis?
Deep vein thrombosisect!
Acute arterial occlusion
Cellulitis
Peripheral artery disease
Question 5
pts
An adult patient recently placed on angiotensin-converting enzyme (ACE) inhibitor for
hypertension returns with a report of a dry, persistent cough. On examination, no
indication of a respiratory problem is noted. Which of the following is the most
appropriate intervention?
Correct!
Switch to an angiotensin II receptor blocker
Obtain a chest X-ray with posterior-anterior and lateral views
Continue the ACE inhibitor and prescribe a mild antitussive
,Continue the current treatment regimen
Question 6
pts
A 65 year old alcoholic patient presents with a new onset of persistent palpitations and
anxiety for the past 3 days. Your monitor is applied and an irregularly irregular rhythm is
noted. Which of the following evaluations should be performed first in your treatment?
Ordering a BNP and Vitamin D level
Prescribing amiodarone 150mg IV bolus
Correct!
Ordering a transthoracic echocardiogram
After 48-72 hrs of atrial fibrillation, the presence of thrombus must be excluded before any
rhythm-modifying intervention. Transthoracic echo is the gold standard for a quick look for any
clot burden, most likely found in the left atrial appendage. Amiodarone is likely to convert the
patient to a sinus rhythm and needs to be done only after determining no evidence of thrombus
is present. BNP and vitamin D are inconsequential in the treatment of A-fib (TSH, serum K, and
magnesium would be valuable). Bilateral radial pulse checks are not assessed for a-fib, but rather
for patients with concern for aortic dissection and/or vascular blockage (subclavian stenosis,
thoracic outlet syndrome, etc)
Palpating pulses bilaterally to identify unilateral pulse deficit
Question 7
pts
A 70-year-old man with a history of atrial fibrillation presents with sudden-onset left-
sided weakness and slurred speech. What is the most likely diagnosis?
Seizure
Transient ischemic attack (TIA)
, Myocardial infarction (MI)
Correct!
Stroke
The patient with a history of atrial fibrillation for over 48 hours without anticoagulation
is at risk of an embolic stroke, secondary to mobilization of a thrombus (90% of which
occur in the left atrial appendage). A patient exhibiting signs of a stroke such as unilateral
weakness and slurred speech, in addition to being evaluated for stroke with cranial
imaging to rule out a hemorrhagic etiology, should also be evaluated for a cardiac
etiology as noted above with an echocardiogram.
Question 8
pts
What is the key long-term benefit of using carvedilol for patients with coronary artery
disease and heart failure with reduced ejection fraction (HFrEF)?
Reduction in cardiac output
Increase in libido
Baseline reduction of blood pressure
Correct!
Potential increase in ejection fraction
EF increase is a key reason for using carvedilol over metoprolol for patients with low EF states.
Libido unfortunately can be negatively impacted by any beta blocker. Cardiac output should only
improve with long term use, not decrease, and beta blockers may reduce blood pressure slightly,
but that is not their key long-term benefit. In fact, they are not even considered for routine anti-
hypertensive management per JNC-8 guidelines.
Question 9
pts
