Advanced Health Assessment and Diagnostic Reasoning, 3rd Edition Test Bank

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Pharm acotherapy Principles & PracticeFourth Edition TESTBANK/STUDYGUIDECHAPTER1. Introduction1.WhatisthenameunderwhichadrugislistedbytheU.S.FoodandDrugAdministration(FDA)?a.Brandb.Nonproprietaryc.Officiald.Trademark2.Whichsourcecontainsinformationspecifictonutritionalsupplements?a.USPDictionaryofUSAN&InternationalDrugNamesb.NaturalMedicinesComprehensiveDatabasec.UnitedStatesPharmacopoeia/NationalFormulary(USPNF)d.DrugInteractionFacts3.Whatisthemostcomprehensivereferenceavailabletoresearchadruginteraction?a.DrugFactsandComparisonsb.DrugInteractionFactsc.HandbookonInjectableDrugsd.MartindaleTheCompleteDrugReference4.Thephysicianhaswrittenanorderforadrugwithwhichthenurseisunfamiliar.WhichsectionofthePhysiciansDeskReference(PDR)ismosthelpfultogetinformationaboutthisdrug?a.Manufacturerssectionb.BrandandGenericNamesectionc.ProductCategorysectiond.ProductInformationsection5.Whichonlinedrugreferencemakesavailabletohealthcareprovidersandthepublicastandard,comprehensive,uptodatelookupanddownloadableresourceaboutmedicines?a.AmericanDrugIndexb.AmericanHospitalFormularyc.DailyMedd.PhysiciansDeskReference(PDR)6.WhichlegislationauthorizestheFDAtodeterminethesafetyofadrugbeforeitsmarketing?a.FederalFood,Drug,andCosmeticAct(1938)b.DurhamHumphreyAmendment(1952)

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c.ControlledSubstancesAct(1970)d.KefauverHarrisDrugAmendment(1962)7.Meperidine(Demerol)isanarcoticwithahighpotentialforphysicalandpsychologicaldependency.Underwhichclassificationdoesthisdrugfall?a.Ib.IIc.IIId.IV8.WhatwouldtheFDAdotoexpeditedrugdevelopmentandapprovalforanoutbreakofsmallpox,forwhichthereisnoknowntreatment?a.Listsmallpoxasahealthorphandisease.b.Omitthepreclinicalresearchphase.c.Extendtheclinicalresearchphase.d.Fasttracktheinvestigationaldrug.9.Whichstatementistrueaboutoverthecounter(OTC)drugs?a.TheyarenotlistedintheUSPNF.b.Aprescriptionfromahealthcareproviderisneeded.c.Theyaresoldwithoutaprescription.d.Theyareknownonlybytheirbrandnames.10.Whichisthemostauthoritativereferenceformedicationsthatareinjected?a.PhysiciansDeskReferenceb.HandbookonInjectableDrugsc.DailyMedd.HandbookofNonprescriptionDrugs11.ThenurseisadministeringLomotil,aScheduleVdrug.Whichstatementistrueaboutthisdrugsclassification?a.Abusepotentialforthisdrugislow.b.Psychologicaldependencyislikely.c.Thereisahighpotentialforabuse.d.Thisdrugisnotacontrolledsubstance.12.Thenurseistranscribingneworderswrittenforapatientwithasubstanceabusehistory.Choosethemedicationorderedthathasthegreatestriskforabuse.a.Lomotilb.Diazepamc.Phenobarbital

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d.Lortab13.Thenurseiscaringforapatientnewlydiagnosedwithtype1diabetesmellitus.Whichapproach(es)totherapeuticmethodswouldbeconsideredinthispatientstreatment?(Selectallthatapply.)a.Therapeuticdrugsb.Concentratedcarbohydratedietc.Familycenteredcared.Regulardailyexerciseandactivitye.Dailybaths14.Anolderadultexperiencingshortnessofbreathisbroughttothehospitalbyherdaughter.Whileobtainingthemedicationhistoryfromthepatientandherdaughter,thenursediscoversthatneitherhasalistofthepatientscurrentmedicationsorprescriptions.Allthepatienthasisaweeklypilldispenserthatcontainsfourdifferentpills.Theprescriptionsarefilledthroughthelocalpharmacy.Whichresource(s)wouldbeappropriatetouseindeterminingthemedicationnamesanddoses?(Selectallthatapply.)a.MartindaleTheCompleteDrugReferenceb.PhysiciansDeskReference,Section4c.Seniorcitizenscenterd.Patientshomepharmacy15.Thenurseplanningpatientteachingregardingdrugnameswouldincludewhichstatement(s)?(Selectallthatapply.)a.Mostdrugcompaniesplacetheirproductsonthemarketundergenericnames.b.TheofficialnameisthenameunderwhichthedrugislistedbytheU.S.FoodandDrugAdministration(FDA).c.Brandnamesareeasiertopronounce,spell,andremember.d.Thefirstletterofthegenericnameisnotcapitalized.e.Thechemicalnameismostmeaningfultothepatient.16.Whencategorizing,thenurseisawarethatwhichdrug(s)wouldbeconsideredScheduleII?(Selectallthatapply.)a.Marijuanab.Percodanc.Amphetaminesd.Fiorinale.FlurazepamAnswers1. C2. C

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3. B4. B5. C6. A7. B8. D9. C10. B11. A12. D13. A,B,D14. B,D15. B,C,D16.B,C

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CHAPTER 2.GERIATRICS1. The following is an accurate description of the aging population:A. The number of older adults will reach 17 million in 2030B. The ratio of women to men will no longer existC. The surviving baby boomers will be more racially diverse than previous eldersD. The surviving baby boomers will have less financial resources than previouseldersE. The minority elder populations are projected to decrease in 20202. Education and health literacy in the older Americans can be described as:A. In 2007, 62% of Hispanic elders had high school degreesB. Nearly 20% of people 75 years and older have low health literacyC. In 2007, 62% of black elders had high school degreesD. Nearly 40% of people 75 years and older have low health literacyE. None ofthe above3. Following are common chronic conditions older Americans have:A. Diabetes, hypertension, cancerB. Hypertension, Alzheimer disease, Parkinson diseaseC. Asthma, stroke, hypothyroidismD. Chronic lower respiratory diseases, Alzheimer disease, strokeE. Cancer, heart disease, Parkinson disease4. The most important pharmacokinetic change that occurs with aging is:A. Reduced renal functionB. Delayed gastric emptyingC. Increased conjugationD. Phase II hepatic metabolismE. Deconditioning5. Allof the following are incorporated into the Cockcroft–Gault equation except:A. AgeB. GenderC. Serum albuminD. Serum creatinineE. Weight6. Because of pharmacodynamic changes, older adults have increased sensitivity to:A. AcetaminophenB. MetforminC.AspirinD. MorphineE. Cyanocobalamin7. Polypharmacy use in older adults does not result in:A. Increased adherenceB. Increased drug–drug interactionC. Increased complex regimenD. Increased hospitalizationE. Increased health care cost8.According to the 2012 Beers criteria, the following drug should be avoided in olderadults:

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A. DiazepamB. WarfarinC. AspirinD. PravastatinE. Mirtazapine9. The following statement about pain in older adults is true:A. Older adults do not feel as muchpain as younger adults.B. Older adults experience less addiction when using opioids for nerve pain.C. Pain is not a quality indicator in long-term care facilities because it is not anobjective measure.D. Pain is frequently undertreated and underreported in elders.E. Elders are more comfortable with opioid use because they are closer to end of life.10. The predictors of adverse drug reactions include the following except:A. More than four medicationsB. Longer than 14 days of hospital stayC. More than four active medical problemsD. Smoking historyE. History of alcohol use11. Medication nonadherence among older adults is influenced by:A. More than two prescribersB. Four or more medication changes in past 12 monthsC. History of more than two surgeriesD. Having no caregiver helpE. More than two chronic conditions for at least 10 years12. Anticoagulation therapy in older adults:A. has proven benefit in atrial fibrillationB. should be withheld due to bleeding side effectsC. should bewithheld due to fall risksD. is more beneficial in the very sickE. is less beneficial in the community-dwelling ambulatory patient13. Geriatric assessment:A. should only be performed by a board-certified geriatricianB. is an interprofessional collaborative processC. routinely includes a formal driving evaluation by occupational therapyD. includes history taking from the patient alone without family for maximumprivacyE. is usually done at the hospital during an acute admission14. Quality indicators:A. monitor costs related to pressure ulcer formation in long-term care facilitiesB. are used to measure the environmental quality of outpatient geriatric clinicsC. do not include subjective complaints such as painD. focus on physical health issues anddo not include mental health issuesE. are used by facility administrators and government overseers to identify problemareas15. The following statement about pharmacotherapy in older adults is false:A. Renal function needs to be monitored for patientson digoxin.

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B. Beers criteria indicate inappropriate medications.C. Benzodiazepines may cause significant adverse effects.D. Albumin needs to be monitored for patients on phenytoin.E. Drug monitoring is often unnecessary due to multimorbidity.Answers1. C2. D3. A4. A5. C6. D7. A8. A9. D10. D11. B12. A13. B14. E15. E

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CHAPTER 3. PEDIATRICS1. AJ is a 14-day-old premature male infant, born at 30-week GA, started onampicillin and gentamicin for neonatalsepsis. Which pharmacokineticparameter affects the patient’s dosing frequency of gentamicin?A. AbsorptionB. Protein bindingC. Metabolism—Phase I reactionsD. Metabolism—Phase II reactionsE. Elimination half-life2. Which is an appropriate maintenancefluid requirement for a 4-year-old boywith a weight of 40 pounds?A. ~1400 mL/dayB. ~1600 mL/dayC. ~1800 mL/dayD. ~2000 mL/dayE. ~2200 mL/day3. MM is a 6-month-old male infant who was born at 34-week GA. You areasked to evaluate his renalfunction in preparation for starting intravenousantibiotics. Which method for assessment is most appropriate?A. “Bedside” Schwartz equationB. Cockcroft–Gault equationC. Schwartz (original) equationD. Modification of diet in renal disease (MDRD) equationE. Urine output alone4. PG, a 1-week-old, 2.5-kg girl born at 30-week GA, is to be started ongentamicin for suspected neonatal sepsis. Which of the following is trueregarding PG’s apparent volume of distribution (Vd) in milliliters per kilogramfor gentamicin compared with adults and children with normal renal function?A. Vd will be less than those used in adults and children.B. Vd will be greater than those used in adults and children.C. Vd will be less than those used in adults but similar to children.D. Vd will be greater than those used in adults but less than in children.E. Vd will be the same as adults and children.5. NC is a 5-year-old boy who is to start carbamazepine, an antiepilepticmedication, for seizure disorder. Which pharmacokinetic parameter affects hisdaily dose requirement of carbamazepine, by body weight?A. AbsorptionB. DistributionC. Metabolism—Phase I reactionsD. Metabolism—Phase II reactionsE. Elimination6. Which of the following is not an appropriate treatment of cold symptoms in a1-year-old child?A. Adequate oral fluid intakeB. Dextromethorphan cough syrupC. Honey (orally)

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D. Ibuprofen every 8 hours as needed for feverE. Saline nasal spray as needed7. KC is a 3-week-old male infant born at 37-week GA with aurinary tractinfection (UTI). Which age-dependent factor hinders the use of ceftriaxone forKC’s UTI?A. Gastric pHB. Glomerular filtration rateC. Intrapulmonary circulationD. Serum albuminE. Total body water8. What is the estimated creatinine clearance for a 2-month-old term male infantwhose weight is 4.5 kg, length 23.6 in (60 cm), and serum creatinine 0.5mg/dL (or 44 μmol/L)?A. 16 mL/min/1.73 m2B. 21 mL/min/1.73 m2C. 39 mL/min/1.73 m2D. 54 mL/min/1.73 m2E. 66 mL/min/1.73 m29. In the outpatient setting, which of the following is not a feasible factor toconsider when assessing for potential illness in an infant?A. Behavior such as lethargy and irritabilityB. Body temperatureC. Diaper changes (urine output)D. Oral intakeE. Mean arterial pressure10. Which of the following items would be least appropriate to mix to mask thetaste of medication for a 10-month-old infant?A. ApplesauceB. Chocolate syrupC. HoneyD. Pear pureeE. Strawberry gelatin11. Which patient is at greatest risk for amedication error?A. A 2-year-old girl (12 kg) who is started on amoxicillin suspension withdose rounded within 10% to meet a measurable volume.B. A 3-day-old boy (2.8 kg) who is on a low concentration heparin dripto maintain his umbilical arterial catheter.C. A 7-day-old premature female infant (1.5 kg) who is receivinggentamicin doses using a smart pump for infusion.D. A 10-year-old girl (55 lb [24.9 kg]) started on an insulin drip fordiabetic ketoacidosis.E. A 12-year-old boy (34 kg) started onstarted on oxycodone for acutepain after surgery.12. KT, an 18-month-old girl, swallowed some of her grandfather’s medicationsfrom his weekly pillbox. KT’s grandfather states that he is taking medicationsfor blood pressure, sleep, and high cholesterol.He states that “she is a little

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sleepy and not behaving like herself right now.” Which is the most appropriateaction to manage the accidental ingestion for this child?A. Administer ipecac syrup immediately and induce emesis untilparamedics arriveB. Allow KT to “sleep off” the medication and contact her pediatriciantomorrowC. Direct her family to take KT to the emergency department and contactlocal/regional poison control centerD. Give continuous oral fluids to dilute the medication’s effectsE. Monitor the child’s blood pressure at home and go to the emergencydepartment if it is too low13. Which is false about medication use in pediatric patients?A. Caregivers should be educated about measurement of liquidmedication for eachmedication.B. It is appropriate to recommend a tablet formulation for any child of age5 years and younger.C. Obtaining a child’s medication history should include prescription,over-the-counter, and complementary medications.D. Suspendability, stability, uniformity, and palatability are importantfactors to consider when compounding a liquid formulation.E. When using intravenous formulations, fluid status and comorbiditieslike congenital heart disease should be considered.14. Which statement is falseregarding complementary and alternative medicine(CAM) use in the pediatric population?A. CAM is routinely disclosed in medication histories fromparents/caregivers.B. Common illnesses in which CAM may be used include cancer, asthma,and autism spectrumdisorder.C. Discussion of CAM use should be encouraged with parents/caregivers.D. Drug interactions are possible with CAM use.E. There are limited data regarding the use of ginger and echinacea inchildren.15. Which statement is false regarding off-label use of medications:A. It includes use of a medication outside the licensed age range.B. It is not permitted by law in the pediatric population due to lack ofdata.C. It is based on limited data about the use in infants and children.D. It is used insituations where there is no appropriate pediatric-approvedalternative.E. It includes dosing outside of those recommended by themanufacturer’s package insert.Answers1. E2. A3. C4. B

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5. C6. B7. D8. D9. E10. C11. D12. C13. B14. A15. B

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CHAPTER 4. PALLIATIVE CARE1. JP is being treated for lung cancer, and received his last chemotherapy infusion 3weeks ago. He is currently reporting nausea and vomiting since he startedtaking morphine for hiscancer-related pain. Which of the followingantiemetics would be the best option to treat his uncontrolled nausea andvomiting?A. OndansetronB. AprepitantC. LorazepamD. HaloperidolE. Dolasetron2. A patient diagnosed with advanced COPD isreporting dyspnea associated withthickened pulmonary secretions. The patient has a strong cough reflex and isadequately hydrated. Which of the following is the best option for this patient?A. Oxygen therapyB. Low-dose oral morphineC. Scopolamine patchesD. Nebulized salineE. Lorazepam3. Delirium often presents gradually, with persistent decline in memory and globalfunctioning.A. TrueB. False4. In a patient diagnosed with advanced heart failure, who is demonstrating excessivefluid overload symptoms, which of the following medication should bereduced or discontinued?A. DigoxinB. Beta-adrenergic blockerC. Angiotensin-converting enzyme (ACE) inhibitorD. Loop diureticE. Aspirin5. Nausea secondary to gastroparesis is most appropriately treatedby which of thefollowing agents?A. LorazepamB. HaloperidolC. MetoclopramideD. OndansteronE. Dolasteron6. Which of the following adjuvant is often used in conjunction with standard opioidtherapy for the treatment of severe bone pain?A.AcetaminophenB. CorticosteroidsC. LorazepamD. Tricyclic antidepressantsE. Alprazolam7. Which of the following best describes the cause of death in patients diagnosed with

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Lou Gehrig disease?A. Opportunistic infectionsD. AnorexiaE. Renal failure8.A patient is eligible for the hospice Medicare benefit in the United States if theyhave a terminal diagnosis with of prognosis of less than:A. 1 month if the disease runs its usual courseB. 3 months if the disease runs its usual courseC. 6 months if the disease runs its usual courseD. 12 months if the disease runs its usual courseE. None of the above9. Palliative care is considered appropriate care for which of the following:A. Breast cancerB. Chronic heart failureC. Alzheimer diseaseD. AIDSE. All of the above10. Benzodiazepine as monotherapy in patients with delirium is the treatment ofchoice.A. TrueB. False11. The dose of short-acting opioids for the treatment of breakthrough pain should beequal to:A. 1%–2% of the dailymaintenance doseB. 5%–20% of the daily maintenance doseC. 25%–35% of the daily maintenance doseD. Short-acting opioids should never be used in palliative care12. Low-dose opioids may be effective in treating which of the following:A. NauseaB. VomitingC. DyspneaD. Terminal secretions13. Due to questionable necessity of simvastatin therapy in hospice patients, thismedication should be evaluated for discontinuation in end of life care.A. TrueB. False14. Which of the following agent(s) may be givensublingually?A. LorazepamB. HaloperidolC. AtropineD. All of the above15. Methadone may be used to effectively manage which of the following?A. Neuropathic painB. Visceral painC. Bone painD. All of the above

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Answers1. D2. D3. B4. B5. C6. B7. B8. C9. E10. False11. B12. C13. A14. D15. D

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CHAPTER 5. HYPERTENSION1. A 55-year-old white man with seated office blood pressure (BP) readings of 144/92mm Hg and 136/84 mm Hg is asked to return in 2 weeks forrepeat measurements,which are 138/88 mm Hg and 134/82 mm Hg. Which of the following classifies DG’sBP per the American Society of Hypertension (ASH) and the International Society ofHypertension (ISH) joint Clinical Practice Guidelines for the ManagementofHypertension in the Community?A. Isolated systolic hypertensionB. Stage 1 hypertensionC. PrehypertensionD. Optimal BPE. Stage 2 hypertension2. Lupus-like syndrome is a possible side effect of which of the following drug(s)?A. ClonidineB.MinoxidilC. DoxazosinD. HydralazineE. Reserpine3. A 55-year-old black woman has a history of left ventricular hypertrophy with a leftventricular ejection fraction of 55%. She has had hypertension for 10 years and iscurrently taking chlorthalidone 25mg daily, metoprolol succinate 50 mg daily, andamlodipine 2.5 mg daily. Her averaged BP is 152/94 mm Hg with a heart rate of 54beats/min. Her physical exam is unremarkable and basic metabolic panel revealsserum creatinine of 0.8 mg/dL [71 μmol/L] and potassium of 3.9 mEq/L (3.9mmol/L). She reports allergies to fosinopril and aspirin. Which of the followingrepresents the optimal course of action?A. Increase amlodipine to 5 mg and have her take it at bedtimeB. Increase metoprolol succinate to 100 mg dailyC. Add lisinopril 5 mg dailyD. Add spironolactone 50 mg dailyE. A or B4. A 34-year-old black man presents to your clinic with a BP of 160/94 mm Hg.Repeat readings over the next 2 weeks average 156/92 mm Hg. The patient has nopast medical history with the exception of Crohn disease, which is currently treatedwith chronic steroid therapy. He is also taking an over-the-counter NSAID forongoing back pain. Physical examination and laboratory tests are unremarkable.Appropriate interventions at this time include:A. No intervention because patient most likely has drug-induced hypertensionB. Discontinuation of the NSAIDC. Reassessment of the dose and need for long-ter5. A 68-year-old white man has resistant hypertension, prior myocardial infarction,and chronic kidney disease (CKD; serum creatinine 1.8 mg/dL [159 μmol/L],estimated creatinine clearance 40 mL/min [0.67 mL/s]). You are initiating ramipriltoday. What is the most appropriate timeframe for laboratory follow-up?A. 1 to 2 daysB. 1 to 2weeks

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C. 1 to 2 monthsD. 3 to 4 monthsE. 4 to 6 months6. A 47-year-old Hispanic man has primary hypertension with an average BP of172/98 mm Hg and heart rate of 70 beats/min. His most recent serum potassium is 4.5mEq/L (4.5 mmol/L), serum creatinine is 1.1 mg/dL (97 μmol/L) and calculatedcreatinine clearance is 102 mL/min (1.70 mL/s). Which of the followingantihypertensives would be most appropriate at this time?A. FurosemideB. AtenololC. Chlorthalidone and lisinopril initiated concurrentlyD. Amlodipine and lisinopril initiated concurrentlyE. C or D7. A 67-year-old Asian man with a recent non-ST segment elevation MI (2 weeksago) has an average BP of 148/86 mm Hg and a heart rate of 76 beats/min. Which ofthe following antihypertensive agents ispreferred in this setting?A. Metoprolol tartrateB. AcebutololC. HydrochlorothiazideD. SpironolactoneE. A or B8. Which of the following treatments is (are) the most appropriate for a hypertensiveemergency?A. Normalization of BP within hoursB. Reduction in mean arterial pressure by 25% to 50% within minutes to hoursC. Reduction in mean arterial pressure up to 25% within minutes to hoursD. Administration of sublingual nifedipineE. C and D9. A 65-year-old black man with history ofhypertension, prior MI, and benignprostatic hypertrophy, is currently receiving amlodipine 5 mg QAM and metoprololsuccinate 50 mg once daily. He has an average 24-hour Ambulatory Blood Pressure of156/92 mm Hg and HR of 66 beats/min with notable nocturnal hypertension. Hecomplains of nocturia but states that the swelling in his feet improved when hisamlodipine dose was reduced. Which of the following presents the most clinicallyappropriate course of action?A. Initiate tamsulosin 0.4 mg daily at bedtimeB. Increase amlodipine to 10 mg daily and change to bedtimeC. Increase metoprolol succinate to 50 mg twice dailyD. Initiate chlorthalidone 50 mg daily at bedtimeE. Initiate doxazosin 2 mg daily at bedtime10. A 67-year-old black man has resistant hypertension. Past medical history is alsosignificant for heart failure with left ventricular systolic dysfunction, dyslipidemia,and peripheral vascular disease. Medications currently include lisinopril, carvedilol,and furosemide. Current blood pressure is146/88 mm Hg and when repeated 148/82mm Hg. Which of the following additions to his medication regimen would be aninappropriate choice at this time?

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A. AmlodipineB. FelodipineC. Hydralazine/Isosorbide DinitrateD. MinoxidilE. Spironolactone11. A 32-year-old woman is 20 weeks pregnant and has a history of gestationaldiabetes. She presents with an average BP of 154/96 mm Hg and a heart rate of 60beats/min. Her laboratory results are remarkable for proteinuria, elevated serum uricacid, and low potassium. Which of the following presents the most appropriate courseof action?A. Closely monitor her BP and provide supportive careB. Start Losartan 50 mg daily while monitoring BPC. Start methyldopa 250 mg every 6 hours while monitoring BPD. Start labetalol 100 mg every 12 hours while monitoring BPE. Start chlorthalidone 25 mg daily while monitoring BP12. A 45-year-old black man has a past medical history significant only forhypertension. Despite therapy with lisinopril 40 mg daily,hydrochlorothiazide 12.5mg daily, and amlodipine 10 mg daily, his home and office BPs over the last 2 weeksremain elevated with an average reading of 154/92 mm Hg. All laboratory results arewithin normal limits. Which of the following would be a reasonable change to hisantihypertensive regimen?A. Replace hydrochlorothiazide with chlorthalidone 25 mg dailyB. Add aliskiren 150 mg dailyC. Add spironolactone 50 mg dailyD. Add losartan 25 mg dailyE. B or D13. A 29-year-old woman has had stage 1 hypertension for the past 2 years that hasbeen well controlled (BP range of 100–110/60–65 mm Hg) on lisinopril 10 mg oncedaily. She has successfully implemented lifestyle modifications, losing 14 kg (31 lb)and obtaining a body mass index of 21 kg/m2. She informs you she is going to starttrying to get pregnant. What changes should be instituted with her antihypertensivetherapy at this time?A. Discontinuing lisinopril and monitoring BP closely with lifestyle modificationsB. Discontinuing lisinopril and initiating methyldopaC. Continuing lisinopril because her BP is well controlledD. Reducing lisinopril dose to 2.5 mg daily and maintaining lifestyle modificationsE. Discontinuing lisinopril and starting HCTZ14. A 57-year-old white woman has type 2diabetes, morbid obesity, andhypertension. She is currently taking only lisinopril 20 mg daily and her office bloodpressures are consistently at goal < 140/90 mm Hg, but her home readings aresignificantly higher. Which of the following is a possible explanation for her elevatedhome readings?A. Her home BP cuff is too smallB. She has white coat hypertensionC. Her home BP cuff is too large

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D. She checks her blood pressure immediately after exerciseE. All of the above15. A 56-year-old black woman is currently on verapamil ER 360 mg once daily. Shehas a past medical history of hypertension and atrial fibrillation. Today, her office BPreadings are 137/97 mm Hg and 144/96 mm Hg with a heart rate of 60 beats/min.Which of the following is the most appropriate intervention?A. Add amlodipine 5 mg dailyB. Increase verapamil ER to 360 mg twice dailyC. Add chlorthalidone 12.5 mg dailyD. Add lisinopril 5 mg dailyE. Either C or DANSWERS1. C2. D3. A4. E5. B6. E7. A8. C9. E10. D11. C12. A13. A14. A15. E

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CHAPTER 6. HEART FAILURE1. Which of the following finding, when reduced, indicates impaired systolic function in apatient with heart failure?A. BNPB. SCrC. LVEFD. LVHE. Troponin2. What is the most commonetiology of heart failure?A. IschemicB. Idiopathic, unknown causeC. Viral cardiomyopathyD. Drug-inducedE. HypertensionUse the following to answer questions 3–5:A 58-year-old man presents to the clinic today with complaints of increasing shortness ofbreath while dressing and carrying groceries and a 10 lb (4.5 kg) weight gain. A few monthsprior, he noticed episodes of waking in the middle of the night with shortness of breath,difficulty breathing after walking two flights of stairs, as well as ankle edema. The patienthas a history of osteoarthritis × 10 years, hypertension × 4 years, diabetes mellitus × 5 years,dyslipidemia, and is status post myocardial infarction 2 years ago.Physical exam reveals the following: BP 148/96 mmHg, pulse 98 beats/min, Ht: 5’11’’ (180cm), Wt: 189 lb (86 kg; usual = 178 lb [(+) JVD, (−) HJR or hepatomegaly(+) S3, (+) S4ECG: regular rate/rhythm, evidence of old infarctECHO: EF 33% (0.33)CXR: Crackles bilaterally and cardiomegaly (enlarged heart)Labs:Sodium: 142mE/L (142 mmol/L)Potassium: 3.7 mEq/L (3.7 mmol/L)Magnesium: 1.8 mEq/L (0.90 mmol/L)BUN: 22 mg/dL (7.9 mmol/L)SCr: 1.3 mg/dL (115 μmol/L)BNP: 322 pg/mL (322 ng/L; 93 pmol/L)Current medications:Aspirin 81 mg dailyDiltiazem 180 mg dailyGlipizide 10 mg twice daily for diabetesSimvastatin 20 mg nightly at bedtimeAcetaminophen 500 mg twice daily3. Which of the patient’s medications can exacerbate systolic dysfunction heart failure?A. GlipizideB. DiltiazemC. AcetaminophenD. b and c

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E.All of the above4. Which of the following is TRUE regarding the patient’s current NYHA functional classand stage of heart failure?A. Class III, Stage BB. Class III, Stage CC. Class II, Stage BD. Class II, Stage CE. Class IV, Stage C5. Which of thefollowing is the MOST appropriate ACUTE treatment plan for the patient’sheart failure?A. Add HCTZ 12.5 mg Qday, since creatinine clearance is above 30 mL/min (0.5mL/s)B. Add HCTZ 25 mg Qday, increase dose of diltiazem to 240 mg QdayC. Add furosemide20 mg BID and nesiritide infusion since BNP is elevatedD. Add furosemide 20 mg BID and lisinopril 10 mg Qday, discontinue diltiazemE. Add furosemide 20 mg BID, and carvedilol 3.125 mg twice daily, discontinuediltiazem6. What is the medical term forthe symptom of “feels short of breath when she lies down atnight”?A. OrthopneaB. Hepatojugular refluxC. Paroxysmal nocturnal dyspneaD. Pulmonary congestionE. Peripheral edema7. Which of the following is TRUE regarding ACE inhibitors in heart failure?A. Should be used mainly in severe heart failure, NYHA functional class IVB. Efficacy of ACE inhibitors is a class effectC. May be used in place of hydralazine and isosorbide dinitrate in cases of renaldysfunctionD. Can be replaced by angiotensin receptor blockers if the patient has hyperkalemiaE. Should be discontinued if creatinine clearance decreases by more than 10%8. Which of the following is TRUE regarding β-blockers in heart failure?A. Ideally should be started in setting of congestion to aid in diuresisB. FDA-approved agents include carvedilol and metoprolol succinateC. Metoprolol tartrate is more efficacious than carvedilol for heart failureD. Chronic β-blockade increases ventricular massE. Metoprolol has more potent blood pressure lowering effects compared tocarvedilol9. A 74-year-old woman presents to clinic for heart failure follow-up. She is classified asNYHA FC II. Her blood pressure is 144/82 mm Hg, and most recent EF is 26% (0.26).Her current medication regimen includes lisinopril 20 mg Qday, carvedilol 25 mg BID,digoxin 0.125 mg Qday, and furosemide 20 mg BID. Which of the following would bethe BEST choice to add at this time?A. MetolazoneB. Hydralazine and isosorbideC. Spironolactone

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D.HydrochlorothiazideE. Valsartan10. Mineralocorticoid receptor antagonists (or aldosterone receptor antagonists) have beenshown to reduce mortality in patients with heart failure. Which of the following is TRUEabout MRAs?A. Spironolactone leads more frequently to gynecomastia compared to eplerenoneB. Associated with hypokalemiaC. Can only be used in NYHA functional class IVD. Used after maximizing ACE inhibitors, β-blockers, and digoxinE. Added to loop diuretic when a patient is resistant to its effects to enhance removalof fluid11. A 76-year-old man is admitted to the hospital presenting with peripheral and pulmonaryedema, decreased urinary output, hypotension, and altered mental status. Pertinent values:PCWP = 32 mm Hg (4.3 kPa), Cardiac index(CI) = 1.8 L/min/m2. Based on hispresentation, what hemodynamic subset is he in?A. IB. IIC. IIID. IVE. II and IV12. Which of the following diuretic combinations is used for the purpose of reducingcongestion in the setting of diuretic resistance?A. Hydrochlorothiazide and spironolactoneB. Spironolactone and torsemideC. Furosemide and spironolactoneD. Furosemide and metolazoneE. Nesiritide and spironolactone13. A 68-year-old African American woman is admitted to the hospital for new onsetacutedecompensated heart failure. Her current medications include felodipine 2.5 mg Qdayand atorvastatin 20 mg Qday. Hemodynamic readings include a PCWP of 16 (2.1 kPa)and a CI of 1.8 L/min/m2. Which of the following is the MOST appropriate treatmentplan?A. Fluids, inotropesB. Diuretics, vasodilatorsC. Fluids, inotropes, vasodilatorsD. Diuretics, fluids, inotropesE. Diuretics, inotropes, vasodilators14. Which of the following statements is most appropriate for patient counseling onnonpharmacologic management of heart failure?A. Supervised exercise is recommended including aerobic activity and weight liftingB. Contact health care provider if weight increases by more than 3 lb (1.4 kg) in aday or 5 lb (2.3 kg) in a weekC. Lower dietary sodium intake to no more than 2 grams per dayD. Maintain alcohol intake to no more than 2 drinks per day if diagnosed with

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alcohol-induced cardiomyopathyE. Weight should be kept at 15% above ideal body weight to maintain adequatenutrition absorption15. A 68-year-old woman is admitted for decompensated heart failure, hemodynamic subsetIV. Her current medication regimen includes enalapril 10 mg BID, digoxin 0.125 mgQday, carvedilol 12.5 mg BID, furosemide 80 mg BID, and potassium chloride (K-Dur)40 mEq (40 mmol) BID. Which of the following is TRUE regarding using milrinonetherapy in this patient?A. Milrinone can interact with her β-blocker therapy due to its β-agonist mechanismB. Effects begin to wear off after 72 hours due to toleranceC. Dose needs tobe adjusted in renal dysfunctionD. Milrinone is not appropriate to use in subset IVE. a and cANSWERS1. C2. A3. B4. B5. D6. A7. B8. B9. C10. A11. D12. D13. A14. B15. C

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CHAPTER 7. ISCHEMIC HEART DISEASE1. A50-year-old, nonsmoking woman has no significant past medical history. A physicalexam and laboratory tests reveal the following: Height 5’4” (163 cm), weight 184 lb (83.6 kg),blood pressure 134/80 mm Hg, heart rate 70 beats/min, total cholesterol 184 mg/dL (4.76mmol/L), LDL cholesterol 110 mg/dL (2.84 mmol/L), HDL cholesterol 46 mg/dL (1.19mmol/L), and triglycerides 140 mg/dL (1.58 mmol/L). Which of the following are risk factorsfor IHD in this patient?A. Age, hypertension, dyslipidemiaB. ObesityC.Age, dyslipidemiaD. Obesity, hypertensionE. Hypertension, dyslipidemia2. Which of the following is characteristic of an atherosclerotic lesion in a patient with chronicstable angina?A. Thick fibrous capB. ThrombosisC. Large lipid coreD. Plaque ruptureE. Platelet aggregation3. A 47-year-old man has been prescribed sublingual nitroglycerin tablets for acute relief ofangina symptoms. When counseling him on the proper use of sublingual nitroglycerin, which ofthe following statements is correct regarding when to call 9-1-1?A. Call 9-1-1 if symptoms have not subsided 5 minutes after administrationB. Call 9-1-1 if symptoms have not subsided 30 minutes after administrationC. Call 9-1-1 prior to taking nitroglycerinD. Take 1 tablet every 5minutes as needed for a maximum of three doses; call 9-1-1if symptoms remain 5 minutes after the third doseE. Take one tablet every 8 to 12 hours; call 9-1-1 if dizziness occurs4. A 65-year-old postmenopausal woman has a history of hypertension, dyslipidemia, andchronic stable angina. Her current medications are atenolol 50 mg PO daily, simvastatin 40 mgPO at bedtime, and SL nitroglycerin as needed. She has allergies/intolerances to aspirin(angioedema) and enalapril (cough). Which of the following should be added to her drugregimen to reduce her risk for cardiovascular events?A. clopidogrelB. dipyridamoleC. niacinD. nifedipineE. ticagrelor5. A 45-year-old man diagnosed with hypertension, diabetes, and IHD was recently hospitalizedfor unstable angina. A coronary angiogram performed during hospitalization revealed singlevessel disease not amenable to PCI. He is currently taking carvedilol 6.25 mg PO twice daily,lisinopril 10 mg PO daily, and metformin 500 mg PO twice daily. His blood pressure is126/78mm Hg and heart rate is 62 beats/min. A fasting lipid profile shows the following: LDLcholesterol 127 mg/dL (3.28 mmol/L), HDL cholesterol 36 mg/dL (0.93 mmol/L), andtriglycerides 157 mg/dL (1.77 mmol/L). He is a current smoker. What additional therapy shouldbe considered to treat this patient’s IHD and lower his risk of ischemic events?

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A. Add low-intensity statin (eg, pravastatin 20 mg/day).B. Add moderate-intensity statin (eg, lovastatin 40 mg/day)C. Add high-intensity statin (eg, atorvastatin 80 mg/day)D. Add prasugrelE. Add varenicline6. A 53-year-old woman with a history of hypertension and dyslipidemia undergoes a thoroughcardiac workup for new onset chest tightness and shortness of breath on exertion. A cardiaccatheterization shows no significant coronary artery obstruction. She is believed to havemicrovascular disease. Her blood pressure is 148/90 mm Hg and heart rate is 74 beats/min. Hercurrent medications include benazepril 10 mg PO daily and simvastatin 40mg PO hs. What isthe most appropriate therapy to manage her angina symptoms?A. Increase benazepril to 20 mg dailyB. Add metoprololC. Add aspirinD. Add doxazosinE. Add hydralazine7. What is the recommended treatment duration of dual antiplatelet therapy followingimplantation of a drug eluting stent?A. 1 weekB. 1 monthC. 3 monthsD. 6 monthsE. At least 12 months8. A 60-year-old obese woman with hypertension and dyslipidemia is being started onranolazine for microvascular angina. Her current medications include aspirin 81 mg/day,lisinopril 10 mg daily, metoprolol 50 mg twice daily, and simvastatin 40 mg/day. A fasting lipidprofile reveals the following: LDL cholesterol 65 mg/dL (1.68 mmol/L), HDL cholesterol 54mg/dL (1.40 mmol/L), and triglycerides 108 mg/dL (1.22 mmol/L). What changes, if any, shouldbe made to her statin regimen?A. Change to a low-intensity statin (eg, pravastatin 20 mg/day)B. Change to a high-intensity statin (eg, rosuvastatin 20 mg/day.C. Continue simvastatin 40 mg/dayD. Reduce the dose of simvastatin to 20 mg/dayE. Increase the dose of simvastatin to 80 mg/day9. A 58-year-old woman with hypertension and coronary artery disease underwent percutaneouscoronary intervention with placement of two drug eluting stentsone week ago. Genotyping isdone and reveals that she has the CYP2C19 poor metabolizer phenotype. Which of the followingis the most appropriate antiplatelet therapy for this patient?A. Clopidogrel plus aspirinB. Clopidogrel plus prasugrelC. Prasugrel plus aspirinD. High dose aspirinE. Dipyridamole plus aspirin10. A 56-year-old woman was recently diagnosed with ischemic heart disease. Her currentmedications include conjugated estrogen 0.625 mg/day, fish oil 1 gm twice daily, aspirin 81 mgdaily, atenolol 100 mg daily, lisinopril 20 mg daily, and rosuvastatin 20 mg daily. Which of the

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following changes to the patient’s regimen are appropriate?A. Add clopidogrelB. Add vitamin EC. Change rosuvastatin to pravastatinD. Discontinue conjugated estrogenE. Discontinue fish oil11. A 60-year-old man with a history of hypertension, diabetes, and dyslipidemia is being treatedwith lisinopril 10 mg PO daily, simvastatin 20 mg PO daily, and metformin XR PO 500 mgdaily. His current blood pressure is 150/88 mmHg and heart rate is 80 beats/min. He presentswith complaints of chest pressure and shortness of breath occurring with exertion. He isdiagnosed with variant angina. In addition to sublingual nitroglycerin, what is the mostappropriate change to his drugtherapy?A. Add amlodipineB. Add isosorbide mononitrateC. Add metoprololD. Add ranolazineE. Add thiazide diuretic (eg, chlorthalidone)12. A 55-year-old man with a history of dyslipidemia and ischemic heart disease had amyocardial infarction 3months ago. His current medications are aspirin 81 mg PO once daily,metoprolol XL 200 mg PO daily, simvastatin 40 mg PO at bedtime, and sublingual nitroglycerinas needed. He continues to experience occasional symptoms of angina with exertion. His bloodpressure is 124/70 mm Hg, and his pulse is 60 beats/min. What is the most appropriatepharmacologic intervention?A. Taper off metoprolol and start verapamilB. Add isosorbide mononitrateC. Taper off metoprolol and start nifedipineD. Add diltiazemE. Switch metoprolol to atenolol13. A 63-year-old woman with a past medical history of dyslipidemia and chronic stable anginatreated with aspirin 81 mg PO once daily, atenolol 100 mg PO once daily, simvastatin 40 mg POonce daily, and sublingual nitroglycerinas needed. Her angina symptoms are currently wellcontrolled. Her blood pressure is 148/90 mm Hg, and her pulse is 70 beats/min. What is the mostappropriate addition to therapy to improve the management of this patient’s ischemic heartdisease?A. ramiprilB. isosorbide dinitrateC. ranolazineD. verapamilE. bupropion14. A 59-year-old man has a history of hypertension, dyslipidemia, ischemic heart disease, andpulmonary hypertension. He is currently taking aspirin 81 mg PO daily, atorvastatin 40 mg POdaily, ramipril 5 mg PO daily, metoprolol XL 100 mg PO daily, and sildenafil 20 mg PO thricedaily. His blood pressure is 102/76 mm Hg and heart rate is 60 beats/min. He continues toexperience ischemic symptoms with minimal exertion. What is the most appropriate addition totherapy to improve the management of this patient’s ischemic heart disease?A. Add felodipine

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B. Add isosorbide mononitrateC. Add ranolazineD. Decrease metoprolol XL to 50 mg dailyE. Increase metoprolol XL to 200 mg daily15. A68-year-old man with a history of hypertension, dyslipidemia, and chronic obstructivepulmonary disease was recently diagnosed with chronic stable angina. His current medicationsare chlorthalidone 25 mg PO daily, atorvastatin 40 mg PO at bedtime, salmeterol one inhalationevery 12 hours, fluticasone MDI two puffs twice a day, and albuterol MDI one to two puffsevery 4 hours prn. His vital signs are a heart rate of 86 beats/min and blood pressure of 150/90mm Hg. In addition to sublingual nitroglycerin, what is the most appropriate change to his drugtherapy?A. Start propranololB. Start ranolazineC. Start amlodipineD. Start isosorbide mononitrateE. Start verapamilANSWERS1. B2. A3. A4. A5. C6. B7. E8. D9. C10. D11. A12. B13. A14. C15. E

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CHAPTER 8. ACUTE CORONARY SYNDROMES1. A 68-year-old man with a history of ischemic heart disease develops severe chest pain (8/10on a pain scale) with subsequent ECG depression in leads II, III, and aVF. Serum creatinine is1.0 mg/dL (88 μmol/L) and troponin I is 3.4 ng/mL (3.4 mcg/L; 3400 ng/L). Which of thefollowing differentiates MI from UA in this patient?A. Location of the coronary artery blockadeB. Quality of chest discomfortC. Severity of coronary artery diseaseD. Elevated plasmatroponin concentrationE. ECG changes2. A 76-year-old man with prior history of coronary artery disease, hypertension, hyperlipidemiaand stroke is foundto have STEMI and receives a DES. Which dual antiplatelet regimen is most appropriate for himtoreceive at timeof discharge?A. Aspirin 325 mg and clopidogrel 75 mg dailyB. Aspirin 325 mg and ticagrelor 90 mg twice dailyC. Aspirin 325 mg and prasugrel 10 mg dailyD. Aspirin 81 mg and prasugrel 10 mg dailyE. Aspirin 81 mg and ticagrelor 90 mg twice daily3. An 82-year-old man with STEMI was brought by ambulance to a small community hospitalduring nighttime (offpeak) hours. The nearest hospital with operating catheterization facilities isa 2.5-hour distance away. Which of thefollowing addresses the appropriate reperfusion for this patient?A. Fibrinolytic therapyB. An early invasive strategyC. A delayed invasive strategyD. An ischemia-guided approachE. A percutaneous strategy4. A 54-year-old woman with a CrCl of 20 ml/min (0.33 mL/s) is beingtreated for ACS byutilizing an ischemiaguided strategy. In addition to aspirin 81 mg daily, which of the followingmedication combinations is mostappropriate in this patient?A. Clopidogrel, UFH, abciximabB Ticagrelor, enoxaparin, eptifibatideC. Prasugrel, fondaparinuxD. Ticagrelor, UFHE. Clopidogrel, bivalirudin, tirofiban5. A 62-kg (137-lb) man with CrCl of 55 mL/min (0.92 mL/s) is found to have a NSTE-ACS.Troponin levels,drawn at three separate intervals, are all negative. Which of the following is the preferredantithrombotic regimen,in addition to ASA and clopidogrel if an ischemia-guided strategy is chosen?A. UFH infusion and eptifibatide IV infusion 2 mcg/kg/minB. Enoxaparin 60-mg SC twice dailyC. Bivalirudin bolus plus infusion

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D. Fondaparinux 2.5 mg SC twice dailyE. Bivalirudin bolus plus eptifibatide IV infusion 2 mcg/kg/min6. A 45-year-old patient with STEMI presents to a hospital without the capacity to performprimary PCI. It has been2 hours since the onset of chest discomfort with BPmcg/L; 10,800 ng/L). In addition to ASA and IV NTG which early therapy option would be bestto start within thefirst 24 hours to treat symptoms, and prevent long term complications?A. Clopidogrel, enoxaparin, ramipril, reteplaseB. Clopidogrel, enoxaparin, tenecteplaseC. Reteplase, UFH, metoprolol, enalaprilD. Tenecteplase, bivalirudin, metoprololE. Alteplase, bivalirudin, lisinopril7. Which of the following is a contraindication to eplerenone in apatient with heart failurefollowing MI?A. EF less than 40% (0.40)B. Persistent anginaC. Angioedema to an ACE inhibitorD. Serum potassium of 5.6 mEq/L (5.6 mmol/L)E. Heart rate less than 60 beats/min8. Which of the following represents the most appropriate antiplatelet regimen in a 55-year-oldpatient (weight 70kg [154 lb]) administered tenecteplase 2 hours previously for STEMI?A. 600-mg clopidogrel loading dose, followed by 75 mg dailyB. 300-mg clopidogrel loading dose, followed by 75 mg dailyC.No clopidogrel load, followed by 75 mg dailyD. 60-mg prasugrel loading dose, followed by 5 mg dailyE. 60-mg prasugrel loading dose, followed by 10 mg daily9. Which of the following patients is most likely to receive the most benefit from a GPI?A. A 47-year-old diabetic man with STEMI undergoing primary PCI receiving ticagrelorB A 68-year-old man with NSTE-ACS undergoing PCI receiving bivalirudin and prasugrelC. A 60-year-old woman with negative troponins, receiving clopidogrelD. An 82-year-old man with positive troponins, receiving ticagrelorE. A 53-year-old woman with positive troponins, receiving heparin10. Which of the following anticoagulants is preferred for PCI in a patient with a history ofheparin-inducedthrombocytopenia and ACS?A. UFHB. EnoxaparinC. BivalirudinD. FondaparinuxE. Dalteparin11. Which of the following is the correct coagulation monitoring goal for a patient with ACSreceiving enoxaparin?A. Activated partial thromboplastin time (aPTT) 2.0 to 3.0 times controlB. aPTT 50 to 70 secondsC. Activated clotting time less than 32 seconds

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D. Anti-Xa levels greater than 1.5 IU/mL (1.5 kIU/L)E. No coagulation goal recommended12. Which of the following best describes a patient with ACS who is a candidate for treatmentwith amlodipineadded to β-blocker?A. Continued chest discomfort despite nitrates and atenololB. Acute heart failure while receiving metoprololC. HR of 80 bpm and BP of 150/90 mm Hg while receiving low-dose metoprolol and enalaprilD. Stable chronicobstructive pulmonary disease receiving a low-dose atenololE. Contraindication to metoprolol receiving diltiazem13. In patients undergoing coronary artery bypass graft (CABG) surgery, which of the followingis a preferredantithrombotic strategy in addition to aspirin?A. UFH, discontinue prasugrel 5 days prior to surgeryB. Eptifibatide, discontinue clopidogrel 7 days prior to surgeryC. UFH, discontinue ticagrelor 5 days prior to surgeryD. Fondaparinux, discontinue clopidogrel 5 days prior to surgeryE. Bivalirudin, discontinue prasugrel 24 hours prior to surgery14. Which anticoagulant regimen would be most appropriate for a 76-year-old woman (weight64 kg [141 lb]) withNSTE-ACS with an estimated CrCl of 50 ml/min (0.83 mL/s) undergoingPCI?A. UFH 3800 unit bolus, followed by 800 units/hourB. Enoxaparin 140-mg SC twice dailyC. Fondaparinux 2.5-mg SC dailyD. Bivalirudin 24.5-mg bolus, followed by 35 mg/kg/hour infusionE. No anticoagulant needed15. Secondary interventions proven to reduce risk afterACS include allthe following except:A. Pneumococcal vaccination in age older than 65 yearsB. Cardiac rehabilitationC. Nonsteroidal anti-inflammatory agentsD. Cholesterol managementE. Dual antiplatelet therapyANSWERS1. D2. E3. A4. D5. B6. B7. D8. B9. E10. C11. E12. A13. C14. A15. C

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CHAPTER 9. ARRHYTHMIAS1. Where in the heart is the atrioventricular (AV) node located?A. High right atriumB. Low right atriumC. Junction of the atria and ventriclesD.High right ventricle2. Which phase of the ventricular action potential is most likely to be altered by a sodiumchannel blocking drug?A. Phase 0B. Phase 1C. Phase 2D. Phase 33. Which one of the following ECG intervals or durationscorresponds most closely to phase 3 onthe ventricular action potential?A. PR intervalB. QRS complexC. QT intervalD. T wave4. Which one of the following arrhythmias increases the risk of stroke two-to sevenfold?A. Atrial fibrillation (AF)B. Paroxysmal supraventricular tachycardia (PSVT)C. Ventricular premature depolarizations (VPDs)Arrhythmias 2D. Ventricular tachycardia (VT)5. Which one of the following most accurately describes the mechanism of AF?A. Increased automaticity in the atria, triggering a single atrial reentrant circuitB. Increased automaticity in the atria, triggering multiple simultaneous atrial reentrant circuitsC. Increased automaticity in the pulmonary veins, triggering a single atrial reentrant circuitD. Increased automaticity in the pulmonary veins, triggering multiple simultaneous atrialreentrant circuits6. Which one of the following most accurately describes the mechanism of PSVT?A. A single reentrant circuit in the atriumB. Multiple simultaneous reentrant circuits inthe atriaC. Reentry involving the AV nodeD. Reentry occurring in the ventricles7. Which of the following is the common myocardial pathology associated with hypertension,ischemic heart disease, heart failure, and valve disease that promotes theelectrophysiologicalalterations that result in atrial fibrillation?A. Fibrosis of the SA nodeB. Fibrosis of the AV nodeC. Left atrial hypertrophyD. Left ventricular hypertrophy8. A 66-year-old man presents to the ED complaining of palpitations, dizziness, lightheadedness,and near-syncope. Past medical history is significant for hypertension for 10 years.ECG reveals an irregularly irregular rhythm with no visible P waves and an undulating baseline.Arrhythmias 3

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