Chap 10 Cardiovascular

Question 1

____ 1. Which group would most benefit from statins?
a.
Those with a low density lipoprotein-cholesterol greater than 100 mg/dL
b.
Individuals with clinical arteriosclerotic cardiovascular disease
c.
Individuals with a 10-year risk greater than 10%
d.
Individuals of all ages with diabetes mellitus (DM)

Answer 1

1. B. Individuals with clinical arteriosclerotic cardiovascular disease

Question 2

\_\_\_\_	2.	If chest pain can be alleviated with time, analgesics, and heat applications, what might the differential diagnosis be?
a.
Peptic ulcer
b.
Hiatal hernia
c.
Costochondritis
d.
Pericarditis

Answer 2

2. C. costochondritis

Question 3

\_\_\_\_	3.	Sandra has palpitations that occur with muscle twitching, paresthesia, and fatigue. What specific diagnostic test might help determine the cause?
a.
Serum calcium
b.
Electrocardiogram (ECG)
c.
Thyroid-stimulating hormone test
d.
Complete blood cell count

____

Answer 3

3. A. Serum Calcium

Question 4

\_\_\_\_	4.	A blood pressure (BP) of 150/90 is considered:
a.
Stage 2 hypertension
b.
Hypertensive
c.
Normal in healthy older adults
d.
Acceptable if the patient has DM

Answer 4

4. C. Normal in healthy older adults

Question 5

____ 5. Lifestyle modifications to manage hypertension (HTN) include:
a.
Maintaining a body mass index of 17
b.
Restricting dietary sodium to 2 grams per day
c.
Engaging in exercise or physical activity for 90 minutes a day
d.
Limiting beer intake to 24 ounces per day

Answer 5

5. D. Limiting beer intake to 24 ounces per day

Question 6

‘Mary has hypertension and previously had a stroke. Which hypertensive drug would you order for her?
a.
Angiotensin converting enzyme inhibitor
b.
Calcium channel blocker
c.
Angiotensin II receptor blocker
d.
Beta blocker

Answer 6

6. A. Angiotensin converting enzyme inhibitor

Question 7

‘
\_\_\_\_	7.	Which high-density lipoprotein (HDL) level is considered cardioprotective?
a.
Greater than 30
b.
Greater than 40
c.
Greater than 50
d.
Greater than 60

Answer 7

7. D. Greater than 60

Question 8

\_\_\_\_	8.	You are assessing Sigred for metabolic syndrome. Which of her parameters is indicative of this syndrome?
a.
Her waist is 36 inches.
b.
Her triglyceride level is 140 mg/dL.
c.
Her BP is 128/84.
d.
Her fasting blood sugar (BS) is 108 mg/dL.

Answer 8

8. A. Her waist is 36 inches

Question 9

\_\_\_\_	9.	Which type of angina do you suspect in Harvey, who complains of chest pain that occurs during sleep and most often in the early morning hours?
a.
Stable angina
b.
Unstable angina
c.
Variant (Prinzmetal’s angina)
d.
Probably not angina but hiatal hernia

Answer 9

9. C. Variant (Prinzmetal’s angina)

Question 10

\_\_\_\_	10.	Which ECG change is typical of cardiac ischemia?
a.
T-wave inversion
b.
ST-segment elevation
c.
Significant Q wave
d.
U-wave

Answer 10

10. A. T-wave inversion

Question 11

Which information should be included when you are teaching your patient about the use of nicotine gum?
a.
The gum must be correctly chewed to a softened state and then placed in the buccal mucosa.
b.
Patients should not eat for 30 minutes prior to or during the use of the gum.
c.
Initially, one piece is chewed every 30 minutes while awake.
d.
Acidic foods and beverages should be encouraged during nicotine therapy.

____

Answer 11

A. The gum must be correctly chewed to a softened state and then placed in the buccal mucosa.

Question 12

Your patient states he has a strep throat infection. Which of the following symptoms makes you consider a viral etiology instead?
a.
Fever
b.
Headache
c.
Exudative pharyngitis
d.
Rhinorrhea

Answer 12

D. Rhinorrhea

Question 13

What is the first-line recommended treatment against Group A β-hemolytic streptococci (GABHS), the most common cause of bacterial pharyngitis?
a.
Penicillin
b.
Quinolone
c.
Cephalosporin
d.
Macrolide

Answer 13

A. Penicillin

Question 14

\_\_\_\_	11.	In which type of arterioventricular (AV) block does the pulse rate (PR) interval lengthen until a beat is dropped?
a.
First-degree AV block
b.
Second-degree Mobitz I AV block
c.
Second-degree Mobitz II AV block
d.
Third-degree AV block

Answer 14

11. 11. ANS: B PTS: 1

Second-degree Mobitz I AV block

Question 14

12.	A Delta wave on the ECG may be present in which condition?
a.
Prinzmetal’s angina
b.
Bundle branch block
c.
Wolff-Parkinson-White syndrome
d.
Aortic stenosis

Answer 14

12. ANS: C PTS: 1Wolff-Parkinson-White syndrome

Question 14

\_\_\_\_	13.	Which heart sound may be heard with poorly controlled hypertension, angina, and ischemic heart disease?
a.
A physiologic split S2
b.
A fixed split S2
c.
S3
d.
S4

____

Answer 14

13. ANS: D PTS: 1S4

Question 15

\_\_\_\_	14.	Samuel is going to the dentist for some work and must take endocarditis prophylaxis because of his history of:
a.
Severe asthma
b.
A common valvular lesion
c.
Severe hypertension
d.
A prosthetic heart valve

Answer 15

14. ANS: D PTS: 1A prosthetic heart valve

Question 16

15.	George, age 64, has cardiovascular disease (CVD), a total cholesterol of 280 mg/dL, and a systolic BP of 158. He is being treated for hypertension. You are doing a Framingham Risk Assessment on him. Which assessment factor would give him the highest number of points on the scale?
a.
His age
b.
His cholesterol level
c.
His systolic BP
d.
The fact that he is on antihypertensiv

Answer 16

15. ANS: B

His cholesterol level

Question 17

16 \_\_\_\_	16.	Which pain characteristic is usually indicative of cardiac pathology?
a.
Fleeting
b.
Moving
c.
Diffuse
d.
Localized

Answer 17

16. ANS: C PTS: 1Diffuse

Question 18

17	17.	What percentage of patients with angina pectoris will have simultaneous dyspnea, caused by transient increase in pulmonary venous pressures that accompany ventricular stiffening during an episode of myocardial ischemia?
a.
About 20%
b.
About 30%
c.
About 50%
d.
Almost all

Answer 18

17. ANS: B PTS: 1

About 30%

Question 19

18 ____ 18. Nitroglycerine (NTG) is given for a patient having ischemic chest pain. One tablet or one spray should be used under the tongue every 5 minutes for three doses. What should be done if the pain has not been relieved after three doses?
a.
911 should be called, and the patient should be transported immediately to the emergency department.
b.
One more dose of NTG may be tried.
c.
The person should be given two aspirin to chew.
d.
A portable defibrillator should be located to ascertain the cardiac rhythm.

Answer 19

18. ANS: A PTS: 1

911 should be called, and the patient should be transported immediately to the emergency department.

Question 20

19
\_\_\_\_	19.	For the best therapeutic effect after a myocardial infarction (MI), thrombolytics should be administered within the first 3 hours (ideally 30 minutes) of symptom onset. Studies have shown, however, that thrombolytic therapy can be of benefit up to how many hours after the initial presentation of MI symptoms?
a.
6 hours
b.
8 hours
c.
10 hours
d.
12 hours

Answer 20

19. ANS: D PTS: 112 hours

Question 21

20
\_\_\_\_	20.	When teaching post MI patients about their NTG tablets, the clinician should stress that the tablets should remain in the light-resistant bottle in which they are packaged and should not be put in another pill box or remain in areas that are or could become warm and humid. Once opened, the bottle must be dated and discarded after how many months?
a.
1 month
b.
3 months
c.
6 months
d.
As long as the tablets are kept in this special bottle, they will last forever.

Answer 21

20. ANS: C PTS: 1

6 months

Question 22

21.	There are four stages of heart failure, classified as A to D, that describe the evolution and progression of disease. In which stage are patients hospitalized or treated with specialized interventions or hospice care for refractory symptoms of heart failure despite medical therapy?
a.
Stage A
b.
Stage B
c.
Stage C
d.
Stage D

Answer 22

21. ANS: D PTS: 1

Stage D

Question 23

``` 22 ____ 22. Which of the following is abundant in the heart and rapidly rises in the bloodstream in the presence of heart failure, making it a good diagnostic test? a. B-type natriuretic peptide b. C-reactive protein c. Serum albumin d. Erythrocyte sedimentation rate ```

Answer 23

22. ANS: A PTS: 1 B-type natriuretic peptide

Question 24

23 ``` ____ 23. Which test has long been considered the gold standard for a diagnosis of venous thromboembolism? a. Ultrasound b. Magnetic resonance imaging (MRI) c. Ascending venogram d. D-dimer ```

Answer 24

23. ANS: C PTS: 1 Ascending venogram

Question 25

``` 24 ____ 24. Statins are approved for which age group? a. Children over the age of 2 b. Children over the age of 6 c. Children over the age of 10 d. Only adolescents and adults ```

Answer 25

24. ANS: C PTS: 1 Children over the age of 10

Question 26

25 ____ 25. The American College of Cardiology/American Heart Association states which of the following regarding the use of non-statin lipid-lowering agents? a. Nicotinic acid derivatives are effective for lowering LDL and triglycerides (TGs). b. Bile acid sequestrates increase HDL. c. Cholesterol absorption inhibitors decrease LDL. d. There is no sufficient evidence to use non-statin lipid-drugs.

Answer 26

25. ANS: D PTS: 1 There is no sufficient evidence to use non-statin lipid-drugs.

Question 27

``` 26 ____ 26. Which of the following medications can cause hyperlipidemia? a. Diuretics b. NSAIDs c. Opioids d. Insulin ```

Answer 27

Diuretics | 26. ANS: A PTS: 1

Question 28

``` 27 ____ 27. Jamie, age 55, has just started on a statin after having his liver function tests (LFTs) come back normal. He now asks you how often he has to have the LFTs repeated. What do you tell him? a. Initially in 6 weeks b. Every 3 months c. Every 6 months d. It’s no longer necessary for his statin regimen. ```

Answer 28

27. ANS: D PTS: 1 It’s no longer necessary for his statin regimen.

Question 29

``` 28 28. In the CHADS2 Index for the stroke risk score for AF, the ‘A’ stands for: a. Anticoagulation b. Autoimmune disease c. Age d. Antihypertension ```

Answer 29

28. ANS: C PTS: 1 Age

Question 30

29 ____ 29. Which murmurs are usually ‘watch and wait’? a. Systolic murmurs b. Diastolic murmurs c. They both are dangerous and need immediate attention. d. You can ‘watch and wait’ for both of them.

Answer 30

29. ANS: A PTS: 1 Systolic murmurs

Question 31

30. Which of the following statements about dabigatran is true? a. It is difficult to keep the patient in therapeutic range. b. Anticoagulation cannot be immediately reversed. c. It allows for the use of tPA if the patient has a stroke despite anticoagulation. d. None of the statements are true.

Answer 31

30. ANS: B PTS: 1 Anticoagulation cannot be immediately reversed.

Question 32

``` ____ 31. What value on the ankle-brachial index diagnoses peripheral artery disease? a. Less than 0.25 b. Less than 0.50 c. Less than 0.90 d. Greater than 1 ```

Answer 32

31. ANS: C PTS: 1 Less than 0.90

Question 33

``` 32 32. Your patient with permanent afib asks when he can discontinue his warfarin. You tell him: a. When your internalized normalized ratio reaches 3.0, you can stop taking your warfarin permanently. b. When you no longer feel ill c. One month after your symptoms dissipate d. You’ll probably be on it indefinitely. ```

Answer 33

32. ANS: D PTS: 1 You’ll probably be on it indefinitely.

Question 34

``` ____ 33. You just started Martha on HTN therapy. The Eighth Joint National Committee recommends that if her goal BP is not reached in what length of time, you should increase the initial drug or add a second drug to it? a. 1 month b. 3 months c. 6 months d. 1 year ```

Answer 34

33. ANS: A 1 month