Final Exam questions
More than half of all cardiac arrhythmias involve the atria.
What are the most common symptoms caused by tachyarrhythmias?
For women with known CAD and diabetes, which is most appropriate to assess CAD risk?
Coronary bypass surgery
ETT with imaging
Of the following, which is the best answer when asked for an advantage of echocardiogram exercise testing over thallium stress testing?
Does not depend on operator experience
Costs are the same
Results are available more quickly
Doesn’t matter because there are no advantages
Your patient has uncomplicated pyelonephritis. In deciding your recommended treatment, you consider the most common pathogenic reason for this diagnosis. What pathogen accounts for the majority of pyelonephritis?
What purpose does the principle of fidelity serve in the provider/patient relationship?
Ensures that providers honor their commitments to the patient
Obligates the provider to a one-on-one relationship with the individual
Ensures that patients receive whatever they want
Maintains costs in the healthcare arena
In CAD, after both systolic and diastolic dysfunction have occurred, the typical pattern of chest pain and related EKG changes occur. During an EKG, you should expect to see ST-segment and T-wave changes that are central to demonstration of ischemia occurring relatively late in the ischemic cascade. Is this true or false?
The leads on the ECG showing ischemic changes during or immediately after an ETT can correlate roughly to the culprit artery or arteries with significant CAD. Is this true or false?
Skin cancer is the most common malignant neoplasm in males in the US. What is the second leading cause of cancer deaths in men greater than 50 years of age?
What ECG changes can reduce the specificity of the ETT?
Exercise induced bundle branch blocks
Paced rhythm and resting bundle branch block
Paced rhythm and exercise induced bundle branch blocks
Low voltage up sloping of the ST-segment
You have confirmed that your patient does indeed have an abdominal aortic aneurysm. In teaching your patient about symptoms to report immediately to the vascular surgeon, you instruct the patient to report which of the following?
Newly diagnosed diabetes
Back pain or flank pain
What is one of the common causes of a Saccular Abdominal Aneurysm?
Poor kidney functioning
Drugs: illicit and prescribed
The diagnostic accuracy of stress testing is decreased among women compared to men for what reasons?
Women having thinner ventricular and septal muscles
Women usually have single vessel or non-obstructive disease
Women cannot exercise as vigorously as men
Women typically have multiple vessel disease
Population disease management is a term used to describe:
High specificity disease states
Low specificity diseases states
Low prevalence specific diseases
High prevalence specific diseases
You receive a report back on the suspected abdominal aortic aneurysm for your patient. It confirms your suspicion of AAA. The report describes the aneurysm as a symmetric weakness of the entire circumference of the aorta. You know that this form of aneurysm is referred to as what kind of aneurysm?
Budging sac aneurysm
Your practice partner just ordered an exercise echocardiography 2DE for a patient with suspected cardiovascular risk. This patient has known resting wall motion abnormalities.Why would this not be the best test to assess this patient’s cardiac risk?
Sensitivity is increased
Sensitivity is decreased
Specificity is increased
Specificity is decreased
Your 60-year old male patient arrives for his appointment. He complains of general malaise and fever over the past several days with low back pain. He also states that he is getting up at night more often to urinate and never feels his bladder is completely empty.What differential diagnosis should you consider in this patient?
Acute viral prostatitis
Acute bacterial prostatitis
We all know that collaboration is integral to becoming a successful nurse practitioner. Among collaborations, however, only one can be considered as the most important. While each example below is important, which is the most important collaboration? The one that occurs:
Between the nurse practitioner and their physician mentor
Between two healthcare providers about a single patient
Between the patient and their family
Between the patient and the nurse practitioner
The sensitivity of a routine ETT is effort dependent. What physiological changes occur during effort in the routine ETT?
Rapid heart rates and coronary artery narrowing
Decrease in coronary blood flow
Decreased heart rate and increased systolic blood pressure
Increased coronary flow and increased systolic blood pressure
A 47-year old female with general complaints of fatigue and shortness of breath shows up in your clinic as a referral from another nurse practitioner. Several blood tests and chest x-rays have been completed without any diagnosis or outstanding abnormalities.You decide to order an ETT despite the fact that the recent ECG does not show any abnormalities. From the answers below, which would be the best answer to support your decision?
You are out of other options
CAD in women is under diagnosed
To please the patient
Women present with the same pattern of CAD as do males
Your patient underwent an exercise stress test for CAD. There is significant elevation of the ST-segment.What do you need to know about these changes to manage your patient’s care?
: This patient needs to see someone more experienced in treatment of CAD
These changes are predictive of myocardial infarction
These changes have minimal predictive value for CAD
These changes predict dire outcomes
When there is a consequential loss of structural integrity of the abdominal aorta, the resulting issue is what condition?
Abdominal aortic aneurysm
You see a 60-year old African American male in your clinic with a recent diagnosis of hypertension. He asks you what he should restrict in his diet, and is particularly interested in limiting his sodium intake. What amount of sodium intake would you recommend on a daily basis for this patient?
No added table salt
Why would inability to exercise reduce the specificity of the routine ETT?
Produces QRS changes that cannot be interpreted
Produces persistent ST-segmental changes and T-wave abnormalities
Causes ST-segment changes and P-wave abnormalities
Will not produce any changes in ECG
By standard criteria, how is a positive stress test defined?
Development of a horizontal or down sloping ST-segment depression of 1mm
Down sloping of the ST-segment at the J point of the QRS
Development of a horizontal or down sloping ST-segment depression of 10mm
Upward sloping ST-segment measured at the J point of the QRS
What are the two types of bradycardia recognized by the American Heart Association?
Relative and absolute
Absolute and pending
Refractory and non-refractory
Relative and dynamic
You see a 75-year old female in your clinic today complaining of urinary incontinence. She is otherwise healthy based upon her last visit. She states that her mother told her this would happen someday because it happens to every woman at some age. What would you tell this patient?
This happens to all women as they age
No need to worry. This is normal. Your mother was correct.
This is not an expected condition related to aging.
This happens to men as well and most women before your age.
What do you know regarding ischemia that is confined to only the posterior and or lateral segments of the left ventricle?
ETT cannot be used for detection
Difficult to detect by ETT
Requires both for detection of changes by ETT
Easier to detect by ETT
What three conditions definitely alter the results of echocardiography in determining CAD?
Obesity, rapid heart rate and lung disease
Diabetes, kidney disease and tooth decay
Obesity, slow heart rates and hypertension
Previous MI, hypotension and diabetes
Specifically, when is an ETT considered to be negative?
Patient has ST-segmental changes with down sloping of greater than 1 mm at 50% of age-predicted maximum heart rate
Patient exercises to 85% of age predicted maximum heart rate without evidence of induced ischemia
Patient exercises to 20% maximum age-predicted heart rate without induced ischemia
Patient exercises until tired without evidence of induced ischemia
All patients, even is asymptomatic, require risk stratification according to the Farmingham risk score. At present, ACC/AHA guidelines, however, do not normally support stress tests for asymptomatic patients without addiitonal justification. From the list below, what could be used to justify a ETT in an asymptomatic patient?
A smoker of 3 weeks
A member of congress
Sedentary and wishes to begin aggressive exercise
BPH is not a risk factor for Prostate cancer. Is this statement true or false?
Spread of genital herpes only occurs during the time period with active lesions. Is this statement true or false?
Abdominal aortic aneurysms are often asymptomatic. What percent of AAA’s are discovered in asymptomatic patients?
Improvements in the delivery and management of healthcare are necessary if we are to improve the overall health of this nation’s population. Which of the following are identified in your readings as strategic in the movement to improve the healthcare system?
President and Congress
Population management and healthcare practice
Socialized medicine and governmental controls
Monetary savings and limited disruption in healthcare delivery
What are the two main types of heart failure?
Systolic and diastolic
Hopeless and severe
Left sided and main
End diastolic and pressure related
The majority of all strokes are non-ischemic. Is this statement true or false?
When a murmur is first heard, it is important to determine if it is due to a pathological condition or benign. For an experienced practitioner, it is always easy to determine the cause of a murmur merely by listening to the sound. Is this statement true or false?
Maintenance of an Isometric ST-segment during exercise is the response of?
A normal heart
An abnormal heart
The goal of self-management is to specifically do what?
Engage patients in their own care
Engage insurance providers in patient care
Engage providers in patient care
Engage government in greater involvement in patient care
Your 56-year old patient presents with bradycardia with a rate of 55 and first degree AV block. The patient is hemodynamically stable and is not experiencing any syncope or chest pain. History includes previous myocardial infarction. Home medications include beta blockers, daily aspirin. Lab work is non-significant for electrolyte imbalance. You decided to treat this patient for the arrhythmia to prevent future destabilization. From the choices below, which might be the appropriate first measure to consider?
Add digitalis to control the heart rate
Consult cardiologist immediately for guidance
Discontinue Beta Blocker and replace with another therapy if necessary
Your patient is morbidly obese and cannot sit on a bicycle or walk a treadmill. She also has marked and severe emphysema. You need to make an assessment of the risk of significant CAD and your patient’s family says that their relative had their diagnosis based on an ultrasound echocardiography. What facts would influence your decision regarding the family request for echo assessment?
Sensitivity would be increased because of lung disease
Specificity would be increased because of obesity
Sensitivity would be reduced because of obesity and lung disease
Specificity would be reduced because of obesity and lung disease
You are in the clinic with your mentor observing the Echocardiogram exercise test of a 45-year old male that has been experiencing slight chest pressure almost daily during exercise.While observing your patient, your mentor points out that the left ventricle wall is thinning and there is some hyperkinesias of the ventricular wall. From your time in the clinic, you know that this test will be considered to be what type of result?
Your patient is newly diagnosed with persistent Atria Fibrillation. You consider electrocardioversion. Before undergoing this procedure you should order the following examination to assess thrombus risk.
X-Ray of chest
Ultrasound of chest
Tachyarrhythmias cause a drop in commonly blood pressure, cardiac output, syncope, shortness of breath, and chest pain. What phenomenon most often occurs during these arrhythmias to cause these symptoms?
At what age is atria fibrillation most common?
60 years or older
Automaticity is a property common to all cardiac cells. Is this statement true or false?
Your patient has a maximum age-predicted heart rate of 180. During the exercise he reaches a heart rate of 140 and then states he can no longer exercise. You see evidence of ischemic changes on the ECG. This would be predictive of what condition?
Low risk of CAD
You tell a patient that he has a murmur. He says he has been told this before, but wonders what causes the unique sounds of a murmur. Which of the following would be your best option?
Turbulent flow of blood
High pressures caused from HTN
There is no reason, it just happens
Almost always from a sclerotic valve
What is the treatment of choice for uncomplicated community-acquired cystitis?
Any antibiotic will treat this diagnosis
Any patient presenting with symptomatic bradycardia should be referred
to a cardiologist for management. Is this statement true or false?
Encouragement of patients to take effective actions in their own healthcare refers to the concept of:
Physician or provider-driven care
Family care givers
You are considering adding an adjunctive form of testing to detect wall motion abnormalities during the ETT.You select Echocardiography as the added testing. You choose this test because you know that echocardiography does what when added to a standard ETT?
Enhances sensitivity and specificity of CAD detection
Enhances sensitivity while reducing specificity of CAD detection
Enhances specificity while not changing sensitivity of detection for CAD
You like pretty pictures of wall motion
Medicaid is mandated to be provided by each state through federal codes. Each state must offer Medicaid exactly as the federal government prescribes. True or false?
What sexually transmitted disease is most widespread in the USA today?
Your preceptor decides to add Doppler Flow studies to the echocardiogram exercise test for a patient with a recent history of a holistic murmur best auscultated at the left steral boarder. The patient has no history of cardiac surgeries. He asks you what might be the main advantages of adding Doppler Flow for this particular patient. You know from your readings that there are several reasons to add Doppler Flow and below are listed more than one correct reason. Your best response for this specific case, however, would be that Doppler Flow studies would be of what additive value during the echocardiogram study?
Detect and evaluate blood shunting from a septal defect
No advantage is seen for this patient
Gives better screen shots of wall abnormalities
Provides assessment of prosthetic valve function
Sexual partners of a patient with a diagnosed STI should always be examined and treated. Is this statement true or false?
Your patient presents with tachycardia. The QRS is measured at 0.10 seconds. Which of the following tachycardias would be an appropriate conclusion based on this information alone?
Premature junctional contractions
A 65-year old white male arrives in your clinic with general complaints of slight abdominal discomfort. He has a known history of smoking two packs per day for 40 years and hypertension. He also has COPD and has been treated numerous times with oral steroids. You consider several optional diagnoses. Of the ones listed below, which should be included as a potential top suspect in your choice of diagnosis?
Chronic bowel obstruction
Abdominal aortic aneurysm
What are the most common mechanisms to produce cardiac arrhythmias?
Decreased automaticity, triggered activity or reentry
Reentry, electrical dysfunction or activity
Stress, hard work or swimming
Enhanced automaticity, triggered activity or reentry