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

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APEA 3P Exam Prep-Cardiovascular:Questions & AnswersWhich patient could be expected to have the highest systolic bloodpressure?A 21-year-old maleA 50-year-old perimenopausal femaleA 35-year-old patient with Type 2 diabetesA 75-year-oldmale(Ans-D.Nearly 25% of the US population has hypertension. The greatest incidenceis in older adults because of changes in the intima of vessels as aging andcalcium deposition occur. Males of any age are more likely to behypertensive than females of the same age. African American adults havethe highest incidence in the general population. Among adolescents,African Americans and Hispanics have the highest rates. Hypertensionoccurs in 5-10% of pregnancies.Mrs. Brandy is having contrast dye next week for a heart catheterization.What drug does NOT need to be stopped prior to her catheterization?NaproxenFurosemideMetforminLosartan(Ans-D.Naproxen and furosemide should be stopped for 24 hours prior to thecatheterization. Metformin should be stopped 48 hours prior to the

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

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This is secondary to long-term smoking.(Ans-B.An absence of hair growth likely indicates peripheral artery disease in thispatient. It is part of normal changes ofaging that hair growth will diminish,but not become absent. His lower extremity pulses should be assessed, hiscardiac risk factors should be assessed (he smoked for years), and heshould be questioned about leg pain when he walks. An ankle-brachialindex could be measured. If < 0.9, further assessment should be done. Anormal ankle-brachial index should be greater than 0.9. Less than 0.4 isconsidered critical.The usual clinical course of mitral valve prolapse:is benign.results in sudden cardiac death.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 mostpatients who have MVP are asymptomatic. A murmur may be present andis best auscultated withthe diaphragm of the stethoscope over the cardiacapex. In a minority of patients, symptoms of heart failure or sudden deathmay occur. When heart failure results, it is usually a result of mitralregurgitation. Embolization may occur, but, this is not common or usual inthe majority of patients.

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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 firstchoice. ACE inhibitors are also indicated in patients who have renalinsufficiency. However, ACE inhibitors can worsen renal insufficiency, sothe patients must be monitored closely with lab tests for BUN, Cr, andpotassium. Diabetes without proteinuria is not a specific indication for ACEinhibitors use, though they are used by some healthcare providers in thisway. This isan off-label use.An older adult who has hypertension and angina takes multiplemedications. Which one of the following decreases the likelihood of hishaving angina?ACE inhibitorBeta blockerDiureticAngiotensin receptor blocker(Ans-B.The beta blocker slows down heart rate, depresses myocardial contractility,and decreases sympathetic stimulation. These decrease myocardialoxygen demand and improve angina symptoms. It is an excellent drugclass to use to prevent symptoms of angina in patients who have

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underlying coronary artery disease. Calcium channel blockers are anotherclass of medications that could be used to improve symptoms of angina.Orthostatic hypotension can be diagnosed in an older adult if the systolicblood pressure decreases:more than 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 hypotension, is diagnosed inolder adults when the systolic blood pressure drops 20 mm Hg or morewithin 3 minutes of moving to a more upright position. Systolic bloodpressure can be expected to decrease within one minute of moving to anupright position. Normally,the blood pressure returns to baseline within oneminute of a position change and orthostatic hypotension does not occur. Itis always abnormal when blood pressure decreases beyond one minute ofmoving to an upright position. Orthostatic hypotension can then bediagnosed. Moving to an upright position may be 1) lying to sitting or 2)sitting to standing. Additionally, if the systolic blood pressure does not meetthese criteria, but the diastolic drops by 10 mm Hg or more with a positionchange, orthostatichypotension can be diagnosed. Patients becomesymptomatic when this occurs and often report lightheadedness,weakness, dizziness, blurred vision, or decreased hearing.Which hypertensive patient is most likely to have adverse blood pressureeffects fromexcessive sodium consumption?

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21-year-old Asian American male35-year-old menstruating female55-year-old post menopausal female70-year-old African American male(Ans-D.Two groups of patients typically experience adverse blood pressure effectsfrom consumption of sodium greater than 2,000 mg daily. Those patientsconsidered to be most sodium-sensitive are elderly patients and AfricanAmerican patients. Thus, choice d is the best choice listed.A patient who takes HCTZ 25 mg daily has complaints of muscle cramps.He probably has:hypocalcemia.hypomagnesemia.hypokalemia.hypercalcemia.(Ans-C.HCTZ is a thiazide diuretic that is potassium-wasting. Patients can becomehypokalemic and experience side effects of this. A common one is musclecramps.A 25-year-old patient has aortic stenosis (AS). The etiology of his AS isprobably:congenital.rheumatic.acquired calcific.unknown.

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(Ans-A.In someone younger than 65 years, the most likely cause is congenital. Theaortic valve usually consists of three cusps, but some people are born witha bicuspid aortic valve. Rheumatic heart disease is the second mostcommon cause of aortic stenosis in this age group, but the incidence hasdecreased drastically in the last many decades because of the use ofantibiotics to treat Streptococcal infections. In more than 90% of patientsolder than 65 years, acquiredcalcifications appear on a normal aortic valveand produce aortic stenosis.A 75-year-old patient with longstanding hypertension takes an ACEinhibitor and a thiazide diuretic daily. He has developed dyspnea onexertion and peripheral edema over the pastseveral days. This probablyindicates:worsening hypertension.development of heart failure (HF).noncompliance with medication.acute myocardial infarction.(Ans-B.The symptoms of dyspnea on exertion and peripheral edema aresymptoms of HF. Long standing hypertension is a risk factor for HF. Acutemyocardial infarction would result in acute symptoms, not development ofsymptoms over the past several days. Noncompliance with medication andfluid or sodium excess might result in peripheral edema and developmentof heart failure.

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A patient with newly diagnosed heart failure has started fosinopril in the lastfew days. She has developed a cough. What clinical finding can helpdistinguish the etiology of the cough as heart failure and not related tofosinopril?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,nonproductive cough that may be described as annoying. Its severity doesnot change with position or time of day. A cough associated with heartfailure is wet, worse when lying down, and is usually described by patientsas worse at night. Choice c is often associatedwith fever and probablyreflects an infectious process like pneumonia.Which choice below would be the best choice for an 80-year-old patientwhose blood pressure is 172/72 mm Hg?ChlorthalidoneAmlodipineMonoprilAcebutolol(Ans-B.This patient has isolated systolic hypertension. According to many learnedauthorities, this is best treated with a long-acting calcium channel blocker,particularly the ones that end in "pine." These belong to the class ofcalcium channel blockers termed dihydropyridines. Thiazide diuretics are

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not potent enough to decrease this patient's blood pressure into normalrange, and its effect is not additive when combined with calcium channelblockers.Which medication could potentially exacerbate heart failure (HF)?NaproxenFurosemideAtorvastatinAspirin(Ans-A.Naproxen is an NSAID. NSAIDs cause sodium retention and thus, waterretention. A single dose of naproxen is unlikely to produce HF symptoms,but repeated subsequent doses are very likely to produce water retentionsufficient to cause edema and possible shortness of breath in susceptiblepeople. The other medications listed are unlikely to have any direct effecton cardiac output in a patientwho has HF.Which patient is most likely to have mitral valve prolapse?An adolescent male with no cardiac historyA 25-year-old male with exercise intoleranceA 30-year-old female with no cardiac historyA 65-year-old male with shortness of breath(Ans-C.Mitral valve prolapse (MVP) is most commonly diagnosed in women aged14-30 years of age. However, it can be found in children (though notusually) or in older adults. The symptoms most commonly associated with

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MVP are arrhythmias (both atrial and ventricular) 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 thepatient is pregnant or not. Echocardiography can beused safely in thispatient because no radiation is emitted from 3D echo. The most commonmurmur in pregnant women is a venous hum murmur. It resolves withinseveral weeks after delivery. It is benign.A patient is diagnosed with mild heart failure (HF).What drug listed belowwould be a good choice for reducing morbidity and mortality long term?VerapamilDigoxinFurosemideMetoprolol(Ans-D.Metoprolol is a beta-blocker. Beta-blockers are known to reduce morbidityand mortality associated with HF. Verapamil is a calcium channel blocker.This class of medications is contraindicated because they decrease thecontractility of the heart. Furosemide and digoxin will improve symptoms

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but not long-term outcomes. Their main benefit is in treating symptomaticpatients.The lipid particle with the greatest atherogenic effect is:Cholesterol.HDL.LDL.triglycerides.(Ans-C.LDL cholesterol promotes atherosclerosis via several differentmechanisms. Consequently, LDL cholesterol tends to be the primary targetwhen patients are treated pharmacologically for elevated lipid levels. LowHDL levels and elevated triglyceride levels can accelerate atherogenesis.A 77-year-old patient has had an increase in blood pressure since the lastexam. The blood pressure readings are provided. If medication is to bestarted on this patient, what would be a good first choice (VS in image)?ACE inhibitorBeta blockerCalcium channel blockerThiazide 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 firstchoice in this patient because it will not be potent enough to decreaseblood pressure by about 20 points to get him to his goal. A long-actingcalcium channel blocker is appropriate for patients who have isolated

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systolic hypertension and will be more likely to get this patient to goalpressurethan HCTZ. Beta-blockers are no longer recommended first-linefor uncomplicated hypertension. ACE inhibitors are very effective inpatients who are high renin producers. Older patients tend to produce loweramounts of renin.The nurse practitioner is caring for an independent 74-year-old female whohad acute coronary syndrome (ACS) about 6 weeks ago. What medicationsshould be part of her regimen unless there is a contraindication?ASA and beta blockerACE and beta blockerACE, ASA, and beta blockerACE,ASA, beta blocker, and statin(Ans-D.After a myocardial event, an aspirin, ACE inhibitor, beta blocker, and statinshould be dosed daily. The aspirin will provide anticoagulation; the ACEinhibitor, statin and beta blocker are associated with reduced morbidity andmortality if given soon after ACS.Mr. Smith is a 72-year-old patient who takes warfarin for chronic atrialfibrillation. His INR and CBC results are provided (CBC in the image, INR4.0). The nurse practitioner should:stop the warfarin for thenext 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.

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An INR range of 2.0-3.0 is therapeutic for most people who take warfarinfor chronic atrial fibrillation. An INR of 4.0 is elevated, and this patient couldsuffer a devastating bleed anywhere in the body. A patient with an INR < 5without bleeding may have warfarin stopped temporarily. The maintenancedose should be decreased when it is safe to resume warfarin, i.e. when theINR is closer to the patient's therapeutic range. If the patient were at highrisk for bleeding, was bleeding, or if the INR was greater than 4.0, vitamin Kcould be administered. A good history should be completed to find out thereason for the increase in INR. A high-risk client with an elevated INRwould be admitted to the hospital and closely monitored, but a client withno comorbidities (no bleeding history or thrombocytopenia) and consideredlow risk, may be monitored as an outpatient. Five days is too long to stopwarfarin without an INR check.A patient with poorly controlled hypertension and history of myocardialinfarction 6 years ago presents today with mild shortness of breath. Hetakes quinapril, ASA, metoprolol, and a statin daily. What symptom is NOTindicative of heart failure?FatigueHeadacheOrthopneaCough(Ans-B.Fatigue is a common symptom in cardiac patients, and it can represent aworsening of many cardiac diseases, such as coronary artery disease,heart failure, or valvular dysfunction. Orthopnea and cough, especially

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nocturnal, are classic symptoms of worsening heart failure. Headache is anonspecific symptom and is not typical of heart failure.You are managing the warfarin dose for an older adult with a prostheticheart valve. Which situation listed requires that warfarin be discontinuednow?INR of 3, somebleedingINR of 8, no significant bleedingINR of 6, no significant bleedingINR of 2 with minimal bleeding(Ans-B.INR is a good measure of the clotting status in an outpatient who takes anoral anticoagulant like warfarin. When warfarin is overdosed and INRclimbs, or when warfarin is overdosed because of food or medication thatproduces deleterious side effects, warfarin doses may be omitted ordiscontinued until the INR is in a more acceptable range. Generally, one ortwo doses may be omitted before rechecking INR and resuming warfarin ordecreasing the dose.A medication that may produce exercise intolerance in a patient who hashypertension is:hydrochlorothiazide.amlodipine.metoprolol.fosinopril.(Ans-C.

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Metoprolol is a cardioselective beta blocker. It can produce bradycardiawhich is responsible for exercise intolerance. As a patient exercises, aconcomitant increase in heart rate allows for an increase in cardiac output.If the heart rate is not able to increase because of beta-blocker influence,neither can the cardiac output. The patient will necessarily slow down hisphysical 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 hypertension has taken hydrochlorothiazide 25mg 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 classto the daily 25 mg hydrochlorothiazide.CorrectStop 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 not allowed thispatient to meet this goal, so it is not acceptable to continue the currentdose. Increasing the hydrochlorothiazide to 50 mg daily will not result in adecrease in blood pressure, only an increase in potassium loss. Adding adrug from a different medication class is a good choice because thecombined effects of antihypertensive medications nearly always produce adecrease in blood pressure and both drugs can be maintained in low dosesto minimize side effects.

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