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. 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.