Skip to content
Past Exams

APEA Cardiovascular 3P Exam Preparation With Answers (97 Solved Questions)

APEA Cardiovascular 3P Exam Preparation With Answers ensures complete exam preparation with authentic past test questions.

Preview 16 of 55 pages

See the first 16 pages exactly as they appear in the document.

  1. Page 1
    Read page 1 as text

    APEA 3P Exam Prep - Cardiovascular : Questions & Answers Which patient could be expected to have the highest systolic blood pressure? A 21 - year - old male A 50 - year - old perimenopausal female A 35 - year - old patient with Type 2 diabetes A 75 - year - old male (Ans - D . Nearly 25% of the US population has hypertension. The greatest incidence is in older adults because of changes in the intima of vessels as aging and calcium deposition occur. Males of any age are more likely to be hypertensive than females o f the same age. African American adults have the highest incidence in the general population. Among adolescents, African Americans and Hispanics have the highest rates. Hypertension occurs in 5 - 10% of pregnancies. Mrs. Brandy is having contrast dye next w eek for a heart catheterization. What drug does NOT need to be stopped prior to her catheterization? Naproxen Furosemide Metformin Losartan (Ans - D. Naproxen and furosemide should be stopped for 24 hours prior to the catheterization. Metformin should be stopped 48 hours prior to the

  2. Page 2
  3. Page 3
    Read page 3 as text

    catheterization. Furosemide is stopped because it contributes to volume depletion. NSAIDs like naproxen are withheld beca use of the impact on renal prostaglandin production. Metformin has been implicated in lactic acidosis when combined with contrast dye in an impaired kidney. In older adults, the three most common ailments are: hearing loss, vision loss, hypertension. hear ing loss, hypertension, arthritis. depression, vision loss, hypertension. arthritis, hearing loss, depression. (Ans - B. Hypertension and arthritis are the two most common ailments in older adults. Hearing loss occurs in half to almost 2/3 of older adults. The most common form is known as presbycusis. There is no consensus for the frequency of screening for hearing loss in older patients, but minimally, it should be grossly evaluated at each visit and screened more thoroughly if deficits are observed. Blood pressure should be screened annually, but it is usually screened at each visit. Arthritis is not routinely screened. Mr. Holbrook, a 75 - year - old male, is a former smoker with a 30 - pack - year history. He has come in today for an annual exam. He walks daily for 25 minutes, has had intentional weight loss, and has a near - normal BMI. On examination, the patient is noted to have an absence of hair growth on his lower legs. Which statement is true regarding this patient? This is a normal consequence of aging. Th is might indicate disease in the lower extremities. It might be from exercise initiation.

  4. Page 4
    Read page 4 as text

    This is secondary to long - term smoking. (Ans - B. An absence of hair growth likely indicates peripheral artery disease in this patient. It is part of normal changes of aging that hair growth will diminish, but not become absent. His lower extremity pulses should be assessed, his cardiac risk factors should be assessed (he smoked for years), and he should be questioned about leg pain when he walks. An ankle - brachial inde x could be measured. If < 0.9, further assessment should be done. A normal ankle - brachial index should be greater than 0.9. Less than 0.4 is considered critical. The usual clinical course of mitral valve prolapse: is benign. results in sudden cardiac dea th. results in chronic heart failure. is associated with multiple episodes of emboli. (Ans - A. The usual course of mitral valve prolapse (MVP) is benign, and most patients who have MVP are asymptomatic. A murmur may be present and is best auscultated with the diaphragm of the stethoscope over the cardiac apex. In a minority of patients, symptoms of heart failure or sudden death may occur. When heart failure results, it is usually a result of mitral regurgitation. Embolization may occur, but, this is not com mon or usual in the majority of patients.

  5. Page 5
    Read page 5 as text

    An ACE inhibitor is specifically indicated in patients who have: hypertension, diabetes with proteinuria, and heart failure. diabetes, hypertension, hyperlipidemia. asthma, hypertension, diabetes. renal nephropathy, heart failure, hyperlipidemia. (Ans - A. ACE inhibitors have numerous indications. Three are indicated in the first choice. ACE inhibitors are also indicated in patients who have renal insufficiency. However, ACE inhibitors can worsen ren al insufficiency, so the patients must be monitored closely with lab tests for BUN, Cr, and potassium. Diabetes without proteinuria is not a specific indication for ACE inhibitors use, though they are used by some healthcare providers in this way. This is an off - label use. An older adult who has hypertension and angina takes multiple medications. Which one of the following decreases the likelihood of his having angina? ACE inhibitor Beta blocker Diuretic Angiotensin receptor blocker (Ans - B. The beta bloc ker slows down heart rate, depresses myocardial contractility, and decreases sympathetic stimulation. These decrease myocardial oxygen demand and improve angina symptoms. It is an excellent drug class to use to prevent symptoms of angina in patients who ha ve

  6. Page 6
    Read page 6 as text

    underlying coronary artery disease. Calcium channel blockers are another class of medications that could be used to improve symptoms of angina. Orthostatic hypotension can be diagnosed in an older adult if the systolic blood pressure decreases: more th an 20 points anytime after rising. more than 20 points within 3 minutes after rising. more than 20 points within 1 minute after rising. any degree drop if the patient becomes weak or dizzy. (Ans - B. Orthostatic hypotension, also called postural hypotensio n, is diagnosed in older adults when the systolic blood pressure drops 20 mm Hg or more within 3 minutes of moving to a more upright position. Systolic blood pressure can be expected to decrease within one minute of moving to an upright position. Normally, the blood pressure returns to baseline within one minute of a position change and orthostatic hypotension does not occur. It is always abnormal when blood pressure decreases beyond one minute of moving to an upright position. Orthostatic hypotension can t hen be diagnosed. Moving to an upright position may be 1) lying to sitting or 2) sitting to standing. Additionally, if the systolic blood pressure does not meet these criteria, but the diastolic drops by 10 mm Hg or more with a position change, orthostatic hypotension can be diagnosed. Patients become symptomatic when this occurs and often report lightheadedness, weakness, dizziness, blurred vision, or decreased hearing. Which hypertensive patient is most likely to have adverse blood pressure effects from excessive sodium consumption?

  7. Page 7
    Read page 7 as text

    21 - year - old Asian American male 35 - year - old menstruating female 55 - year - old post menopausal female 70 - year - old African American male (Ans - D. Two groups of patients typically experience adverse blood pressure effects from cons umption of sodium greater than 2,000 mg daily. Those patients considered to be most sodium - sensitive are elderly patients and African American patients. Thus, choice d is the best choice listed. A patient who takes HCTZ 25 mg daily has complaints of muscl e cramps. He probably has: hypocalcemia. hypomagnesemia. hypokalemia. hypercalcemia. (Ans - C. HCTZ is a thiazide diuretic that is potassium - wasting. Patients can become hypokalemic and experience side effects of this. A common one is muscle cramps. A 25 - year - old patient has aortic stenosis (AS). The etiology of his AS is probably: congenital. rhe umatic. acquired calcific. unknown.

  8. Page 8
    Read page 8 as text

    (Ans - A. In someone younger than 65 years, the most likely cause is congenital. The aortic valve usually consists of three cusps, but some people are born with a bicuspid aortic valve. Rheumatic heart disease is the seco nd most common cause of aortic stenosis in this age group, but the incidence has decreased drastically in the last many decades because of the use of antibiotics to treat Streptococcal infections. In more than 90% of patients older than 65 years, acquired calcifications appear on a normal aortic valve and produce aortic stenosis. A 75 - year - old patient with longstanding hypertension takes an ACE inhibitor and a thiazide diuretic daily. He has developed dyspnea on exertion and peripheral edema over the past several days. This probably indicates: worsening hypertension. development of heart failure (HF). noncompliance with medication. acute myocardial infarction. (Ans - B. The symptoms of dyspnea on exertion and peripheral edema are symptoms of HF. Long standi ng hypertension is a risk factor for HF. Acute myocardial infarction would result in acute symptoms, not development of symptoms over the past several days. Noncompliance with medication and fluid or sodium excess might result in peripheral edema and devel opment of heart failure.

  9. Page 9
    Read page 9 as text

    A patient with newly diagnosed heart failure has started fosinopril in the last few days. She has developed a cough. What clinical finding can help distinguish the etiology of the cough as heart failure and not related to fosinopr il? It is dry and nonproductive. It is wet and worse with recumbence. It is purulent and tachycardia accompanies it. Shortness of breath always results after coughing. (Ans - B. The cough associated with fosinopril, an ACE inhibitor, is a dry, nonproductiv e cough that may be described as annoying. Its severity does not change with position or time of day. A cough associated with heart failure is wet, worse when lying down, and is usually described by patients as worse at night. Choice c is often associated with fever and probably reflects an infectious process like pneumonia. Which choice below would be the best choice for an 80 - year - old patient whose blood pressure is 172/72 mm Hg? Chlorthalidone Amlodipine Monopril Acebutolol (Ans - B. This patient has is olated systolic hypertension. According to many learned authorities, this is best treated with a long - acting calcium channel blocker, particularly the ones that end in "pine." These belong to the class of calcium channel blockers termed dihydropyridines. T hiazide diuretics are

  10. Page 10
    Read page 10 as text

    not potent enough to decrease this patient's blood pressure into normal range, and its effect is not additive when combined with calcium channel blockers. Which medication could potentially exacerbate heart failure (HF)? Naproxen Furosemide Atorvastatin Aspirin (Ans - A. Naproxen is an NSAID. NSAIDs cause sodium retention and thus, water retention. A single dose of naproxen is unlikely to produce HF symptoms , but repeated subsequent doses are very likely to produce water retention sufficient to cause edema and possible shortness of breath in susceptible people. The other medications listed are unlikely to have any direct effect on cardiac output in a patient who has HF. Which patient is most likely to have mitral valve prolapse? An adolescent male with no cardiac history A 25 - year - old male with exercise intolerance A 30 - year - old female with no cardiac history A 65 - year - old male with shortness of breath (Ans - C. Mitral valve prolapse (MVP) is most commonly diagnosed in women aged 14 - 30 years of age. However, it can be found in children (though not usually) or in older adults. The symptoms most commonly associated with

  11. Page 11
    Read page 11 as text

    MVP are arrhythmias (both atrial and ventr icular) and chest pain. However, most patients with MVP are asymptomatic. You have been asked to evaluate a heart murmur in a pregnant patient. Can a 3D echocardiogram be safely used to evaluate her? Yes, but this will not yield the best information. Yes, this is perfectly safe. No, this will emit radiation and is not safe. Yes, but the mother will be exposed to radiation (Ans - B. An echocardiogram is the best test to evaluate a heart murmur whether the patient is pregnant or not. Echocardiography can be used safely in this patient because no radiation is emitted from 3D echo. The most common murmur in pregnant women is a venous hum murmur. It resolves within several weeks after delivery. It is benign. A patient is diagnosed with mild heart failure (HF). What drug listed below would be a good choice for reducing morbidity and mortality long term? Verapamil Digoxin Furosemide Metoprolol (Ans - D. Metoprolol is a beta - blocker. Beta - blockers are known to reduce morbidity and mortality associated with HF. Verap amil is a calcium channel blocker. This class of medications is contraindicated because they decrease the contractility of the heart. Furosemide and digoxin will improve symptoms

  12. Page 12
    Read page 12 as text

    but not long - term outcomes. Their main benefit is in treating symptomatic pat ients. The lipid particle with the greatest atherogenic effect is: Cholesterol. HDL. LDL. triglycerides. (Ans - C. LDL cholesterol promotes atherosclerosis via several different mechanisms. Consequently, LDL cholesterol tends to be the primary target when patients are treated pharmacologically for elevated lipid levels. Low HDL levels and elevated triglyceride levels c an accelerate atherogenesis. A 77 - year - old patient has had an increase in blood pressure since the last exam. The blood pressure readings are provided. If medication is to be started on this patient, what would be a good first choice (VS in image)? ACE in hibitor Beta blocker Calcium channel blocker Thiazide diuretic (Ans - C. This patient is 77 years old and should have a goal blood pressure of < 150/90 mmHg according to JNC8. A thiazide diuretic is not a good first choice in this patient because it will n ot be potent enough to decrease blood pressure by about 20 points to get him to his goal. A long - acting calcium channel blocker is appropriate for patients who have isolated

  13. Page 13
    Read page 13 as text

    systolic hypertension and will be more likely to get this patient to goal pressure than HCTZ. Beta - blockers are no longer recommended first - line for uncomplicated hypertension. ACE inhibitors are very effective in patients who are high renin producers. Older patients tend to produce lower amounts of renin. The nurse practitioner is car ing for an independent 74 - year - old female who had acute coronary syndrome (ACS) about 6 weeks ago. What medications should be part of her regimen unless there is a contraindication? ASA and beta blocker ACE and beta blocker ACE, ASA, and beta blocker ACE, ASA, beta blocker, and statin (Ans - D. After a myocardial event, an aspirin, ACE inhibitor, beta blocker, and statin should be dosed daily. The aspirin will provide anticoagulation; the ACE inhibitor, statin and beta blocker are associated with reduced mor bidity and mortality if given soon after ACS. Mr. Smith is a 72 - year - old patient who takes warfarin for chronic atrial fibrillation. His INR and CBC results are provided (CBC in the image, INR 4.0). The nurse practitioner should: stop the warfarin for the next 4 days and repeat the INR on day 5. admit to the hospital immediately. administer vitamin K and repeat INR in 2 hours. stop the warfarin today and repeat the INR tomorrow. (Ans - D.

  14. Page 14
    Read page 14 as text

    An INR range of 2.0 - 3.0 is therapeutic for most people who take warfa rin for chronic atrial fibrillation. An INR of 4.0 is elevated, and this patient could suffer a devastating bleed anywhere in the body. A patient with an INR < 5 without bleeding may have warfarin stopped temporarily. The maintenance dose should be decreas ed when it is safe to resume warfarin, i.e. when the INR is closer to the patient's therapeutic range. If the patient were at high risk for bleeding, was bleeding, or if the INR was greater than 4.0, vitamin K could be administered. A good history should b e completed to find out the reason for the increase in INR. A high - risk client with an elevated INR would be admitted to the hospital and closely monitored, but a client with no comorbidities (no bleeding history or thrombocytopenia) and considered low ris k, may be monitored as an outpatient. Five days is too long to stop warfarin without an INR check. A patient with poorly controlled hypertension and history of myocardial infarction 6 years ago presents today with mild shortness of breath. He takes quinap ril, ASA, metoprolol, and a statin daily. What symptom is NOT indicative of heart failure? Fatigue Headache Orthopnea Cough (Ans - B. Fatigue is a common symptom in cardiac patients, and it can represent a worsening of many cardiac diseases, such as coronary artery disease, heart failure, or valvular dysfunction. Orthopnea and cough, especially

  15. Page 15
    Read page 15 as text

    nocturnal, are classic symptoms of worsenin g heart failure. Headache is a nonspecific symptom and is not typical of heart failure. You are managing the warfarin dose for an older adult with a prosthetic heart valve. Which situation listed requires that warfarin be discontinued now? INR of 3, some bleeding INR of 8, no significant bleeding INR of 6, no significant bleeding INR of 2 with minimal bleeding (Ans - B. INR is a good measure of the clotting status in an outpatient who takes an oral anticoagulant like warfarin. When warfarin is overdosed an d INR climbs, or when warfarin is overdosed because of food or medication that produces deleterious side effects, warfarin doses may be omitted or discontinued until the INR is in a more acceptable range. Generally, one or two doses may be omitted before r echecking INR and resuming warfarin or decreasing the dose. A medication that may produce exercise intolerance in a patient who has hypertension is: hydrochlorothiazide. amlodipine. metoprolol. fosinopril. (Ans - C.

  16. Page 16
    Read page 16 as text

    Metoprolol is a cardioselective beta bl ocker. It can produce bradycardia which is responsible for exercise intolerance. As a patient exercises, a concomitant increase in heart rate allows for an increase in cardiac output. If the heart rate is not able to increase because of beta - blocker influe nce, neither can the cardiac output. The patient will necessarily slow down his physical activity. Choices a and d have no direct effect on heart rate. Amlodipine is a calcium channel blocker that does not decrease heart rate. A 50 - year - old patient with h ypertension has taken hydrochlorothiazide 25 mg daily for the past 4 weeks. How should the nurse practitioner proceed (VS in image)? Wait 4 weeks before making a dosage change. Increase the hydrochlorothiazide to 50 mg daily. Add a drug from another class to the daily 25 mg hydrochlorothiazide. Correct Stop the hydrochlorothiazide and start a drug from a different class. (Ans - C. The recommended target blood pressure, according to JNC 8, for this 50 - year - old patient is < 140/ 90 mmHg. The current plan has n ot allowed this patient to meet this goal, so it is not acceptable to continue the current dose. Increasing the hydrochlorothiazide to 50 mg daily will not result in a decrease in blood pressure, only an increase in potassium loss. Adding a drug from a dif ferent medication class is a good choice because the combined effects of antihypertensive medications nearly always produce a decrease in blood pressure and both drugs can be maintained in low doses to minimize side effects.

39 more pages in the full document

Unlock it once and it stays in your library, ready to chat with or turn into flashcards.

Unlock the full document

More Nursing study materials

See all

Study this document with CramX

Once it is in your library, every tool can work from it.