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,Q. 4.4. A physical assessment of a 28-year-old female patient indicates that her blood pressure in her
legs is lower than that in her arms & that her brachial pulse is weaker in her left arm than in her right.
In addition, her femoral pulses are weak bilaterally. Which of the following possibilities would her care
provider be most likely to suspect? (Points : 0.4)
Pheochromocytoma
Essential hypertension
Coarctation of the aorta
An adrenocortical disorder
Q. 5.5. A 6-year-old boy has been brought to the emergency department by ambulance after his
mother discovered that his heart rate was “so fast I couldn't even count it.” The child was determined
to be in atrial flutter & his mother is seeking an explanation from the health care team. Which of the
following points should underlie an explanation to the mother? (Points : 0.4)
The child is experiencing a reentry rhythm in his right atrium.
The resolution of the problem is dependent on spontaneous recovery & is resistant to pacing
interventions.
The child is likely to have a normal ECG apart from the rapid heart rate.
The boy's atria are experiencing abnormal sympathetic stimulation.
Q. 6.6. A 66-year-old patient's echocardiogram reveals a hypertrophied left ventricle, normal chamber
volume, & a normal ejection fraction from the heart. What is this patient's most likely
diagnosis? (Points : 0.4)
Mitral valve regurgitation
Aortic valve stenosis
Mitral valve stenosis
Aortic valve regurgitation
Q. 7.7. A 70-year-old male patient presents to the emergency department complaining of pain in his
calf that is exacerbated when he walks. His pedal & popliteal pulses are faintly palpable & his leg distal
to the pain is noticeably reddened. What would his care provider's preliminary diagnosis & anticipated
treatment most likely be?(Points : 0.4)
Acute arterial occlusion that will be treated with angioplasty
Raynaud disease that will require antiplatelet medications
Atherosclerotic occlusive disease necessitating thrombolytic therapy
, Giant cell temporal arteritis that will be treated with corticosteroids
Q. 8.8. A patient in the intensive care unit has a blood pressure of 87/39 & has warm, flushed skin
accompanying his sudden decline in level of consciousness. The patient also has arterial & venous
dilation & a decrease in systemic vascular resistance. What is this patient's most likely
diagnosis? (Points : 0.4)
Hypovolemic shock
Septic shock
Neurogenic shock
Obstructive shock
Q. 9.9. A 31-year-old woman with a congenital heart defect reports episodes of lightheadedness &
syncope, with occasional palpitations. A resting electrocardiogram reveals sinus bradycardia & she is
suspected of having sick sinus syndrome. Which of the following diagnostic methods is the best choice
to investigate the suspicion? (Points : 0.4)
Signal-averaged ECG
Exercise stress testing
Electrophysiologic study
Holter monitoring
Q. 10.10. A nurse practitioner is providing care for several patients on a medical unit of a hospital. In
which of the following patient situations would the nurse practitioner be most likely to rule out
hypertension as a contributing factor? (Points : 0.4)
A 61-year-old man who has a heart valve infection & recurrent fever
An 81-year-old woman who has had an ischemic stroke & has consequent one-sided weakness
A 44-year-old man awaiting a kidney transplant who requires hemodialysis three times per week
A 66-year-old woman with poorly controlled angina & consequent limited activity tolerance
Q. 11.11. A patient is experiencing impaired circulation secondary to increased systemic arterial
pressure. Which of the following statements is the most relevant phenomenon?(Points : 0.4)
Increased preload due to vascular resistance
High afterload because of backpressure against the left ventricle
Impaired contractility due to aortic resistance
Systolic impairment because of arterial stenosis
, Q. 12.12. A number of patients have presented to the emergency department in the last 24 hours with
complaints that are preliminarily indicative of myocardial infarction. Which of the following patients is
least likely to have an ST-segment myocardial infarction (STEMI)? (Points : 0.4)
A 70-year-old woman who is complaining of shortness of breath & vague chest discomfort
A 66-year-old man who has presented with fatigue, nausea& vomiting, & cool, moist skin
A 43-year-old man who woke up with substernal pain that is radiating to his neck & jaw
A 71-year-old man who has moist skin, fever, & chest pain that is excruciating when he moves but
relieved when at rest
Q. 13.13. A formerly normotensive woman, pregnant for the first time, develops hypertension &
headaches at 26 weeks' gestation. Her blood pressure is 154/110 mm Hg & she has proteinuria. What
other labs should be ordered for her? (Points : 0.4)
Plasma angiotensin I & II & renin
Urinary sodium & potassium
Platelet count, serum creatinine, & liver enzymes
Urinary catecholamines & metabolites
Q. 14.14. An older adult female patient has presented with a new onset of shortness of breath, & the
patient's nurse practitioner has ordered measurement of her BNP levels along with other diagnostic
tests. What is the most accurate rationale for the nurse practitioner's choice of blood work? (Points :
0.4)
BNP is released as a compensatory mechanism during heart failure & measuring it can help
differentiate the patient's dyspnea from a respiratory pathology.
BNP is an indirect indicator of the effectiveness of the RAA system in compensating for heart failure.
BNP levels correlate with the patient's risk of developing cognitive deficits secondary to heart failure
& consequent brain hypoxia.
BNP becomes elevated in cases of cardiac asthma, Cheyne-Stokes respirations, & acute pulmonary
edema, & measurement can gauge the severity of pulmonary effects.
Q. 15.15. The nurse practitioner for a cardiology practice is responsible for providing presurgical
teaching for patients who are about to undergo a coronary artery bypass graft. Which of the following
teaching points best conveys an aspect of the human circulatory system? (Points : 0.4)
“Your blood pressure varies widely between arteries & veins, & between pulmonary & systemic
,Q. 4.4. A physical assessment of a 28-year-old female patient indicates that her blood pressure in her
legs is lower than that in her arms & that her brachial pulse is weaker in her left arm than in her right.
In addition, her femoral pulses are weak bilaterally. Which of the following possibilities would her care
provider be most likely to suspect? (Points : 0.4)
Pheochromocytoma
Essential hypertension
Coarctation of the aorta
An adrenocortical disorder
Q. 5.5. A 6-year-old boy has been brought to the emergency department by ambulance after his
mother discovered that his heart rate was “so fast I couldn't even count it.” The child was determined
to be in atrial flutter & his mother is seeking an explanation from the health care team. Which of the
following points should underlie an explanation to the mother? (Points : 0.4)
The child is experiencing a reentry rhythm in his right atrium.
The resolution of the problem is dependent on spontaneous recovery & is resistant to pacing
interventions.
The child is likely to have a normal ECG apart from the rapid heart rate.
The boy's atria are experiencing abnormal sympathetic stimulation.
Q. 6.6. A 66-year-old patient's echocardiogram reveals a hypertrophied left ventricle, normal chamber
volume, & a normal ejection fraction from the heart. What is this patient's most likely
diagnosis? (Points : 0.4)
Mitral valve regurgitation
Aortic valve stenosis
Mitral valve stenosis
Aortic valve regurgitation
Q. 7.7. A 70-year-old male patient presents to the emergency department complaining of pain in his
calf that is exacerbated when he walks. His pedal & popliteal pulses are faintly palpable & his leg distal
to the pain is noticeably reddened. What would his care provider's preliminary diagnosis & anticipated
treatment most likely be?(Points : 0.4)
Acute arterial occlusion that will be treated with angioplasty
Raynaud disease that will require antiplatelet medications
Atherosclerotic occlusive disease necessitating thrombolytic therapy
, Giant cell temporal arteritis that will be treated with corticosteroids
Q. 8.8. A patient in the intensive care unit has a blood pressure of 87/39 & has warm, flushed skin
accompanying his sudden decline in level of consciousness. The patient also has arterial & venous
dilation & a decrease in systemic vascular resistance. What is this patient's most likely
diagnosis? (Points : 0.4)
Hypovolemic shock
Septic shock
Neurogenic shock
Obstructive shock
Q. 9.9. A 31-year-old woman with a congenital heart defect reports episodes of lightheadedness &
syncope, with occasional palpitations. A resting electrocardiogram reveals sinus bradycardia & she is
suspected of having sick sinus syndrome. Which of the following diagnostic methods is the best choice
to investigate the suspicion? (Points : 0.4)
Signal-averaged ECG
Exercise stress testing
Electrophysiologic study
Holter monitoring
Q. 10.10. A nurse practitioner is providing care for several patients on a medical unit of a hospital. In
which of the following patient situations would the nurse practitioner be most likely to rule out
hypertension as a contributing factor? (Points : 0.4)
A 61-year-old man who has a heart valve infection & recurrent fever
An 81-year-old woman who has had an ischemic stroke & has consequent one-sided weakness
A 44-year-old man awaiting a kidney transplant who requires hemodialysis three times per week
A 66-year-old woman with poorly controlled angina & consequent limited activity tolerance
Q. 11.11. A patient is experiencing impaired circulation secondary to increased systemic arterial
pressure. Which of the following statements is the most relevant phenomenon?(Points : 0.4)
Increased preload due to vascular resistance
High afterload because of backpressure against the left ventricle
Impaired contractility due to aortic resistance
Systolic impairment because of arterial stenosis
, Q. 12.12. A number of patients have presented to the emergency department in the last 24 hours with
complaints that are preliminarily indicative of myocardial infarction. Which of the following patients is
least likely to have an ST-segment myocardial infarction (STEMI)? (Points : 0.4)
A 70-year-old woman who is complaining of shortness of breath & vague chest discomfort
A 66-year-old man who has presented with fatigue, nausea& vomiting, & cool, moist skin
A 43-year-old man who woke up with substernal pain that is radiating to his neck & jaw
A 71-year-old man who has moist skin, fever, & chest pain that is excruciating when he moves but
relieved when at rest
Q. 13.13. A formerly normotensive woman, pregnant for the first time, develops hypertension &
headaches at 26 weeks' gestation. Her blood pressure is 154/110 mm Hg & she has proteinuria. What
other labs should be ordered for her? (Points : 0.4)
Plasma angiotensin I & II & renin
Urinary sodium & potassium
Platelet count, serum creatinine, & liver enzymes
Urinary catecholamines & metabolites
Q. 14.14. An older adult female patient has presented with a new onset of shortness of breath, & the
patient's nurse practitioner has ordered measurement of her BNP levels along with other diagnostic
tests. What is the most accurate rationale for the nurse practitioner's choice of blood work? (Points :
0.4)
BNP is released as a compensatory mechanism during heart failure & measuring it can help
differentiate the patient's dyspnea from a respiratory pathology.
BNP is an indirect indicator of the effectiveness of the RAA system in compensating for heart failure.
BNP levels correlate with the patient's risk of developing cognitive deficits secondary to heart failure
& consequent brain hypoxia.
BNP becomes elevated in cases of cardiac asthma, Cheyne-Stokes respirations, & acute pulmonary
edema, & measurement can gauge the severity of pulmonary effects.
Q. 15.15. The nurse practitioner for a cardiology practice is responsible for providing presurgical
teaching for patients who are about to undergo a coronary artery bypass graft. Which of the following
teaching points best conveys an aspect of the human circulatory system? (Points : 0.4)
“Your blood pressure varies widely between arteries & veins, & between pulmonary & systemic
