Np Test 2: Chest Disorders (Cardiac)
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Questions and Answers
- 1.
You examine a 38-year-old woman who has presented for an initial examination and Pap test. She has no complaint. Her BP is 144/98 bilaterally and her body mass index is 31. The rest of her physical exam is unremarkable. Your next best action is to:
- A.
Initiate hypertensive therapy
- B.
Arrange for at least two additional BP measurements during the next 2 weeks
- C.
Order her BUN, creatinine and potassium measurements and a UA
- D.
Advise her to reduce her sodium intake
Correct Answer
B. Arrange for at least two additional BP measurements during the next 2 weeksExplanation
The correct answer is to arrange for at least two additional BP measurements during the next 2 weeks. This is because the patient's blood pressure is elevated at 144/98, which indicates hypertension. However, a single elevated blood pressure reading is not enough to diagnose hypertension. It is recommended to confirm the diagnosis by obtaining multiple blood pressure measurements over a period of time. This will help determine if the elevated blood pressure is sustained or if it was just an isolated reading. Therefore, arranging for additional BP measurements is the next best action to accurately diagnose and manage the patient's hypertension.Rate this question:
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- 2.
You see a 68-year-old woman as a patient who is transferring care to your practice. She has a 10-year history of hypertension, diabetes, and hyperlipidemia. Current medications include HCTZ, glipizide, metformin, simvastatin, and daily low-dose aspirin. Today's BP reading is 138/88 and the rest of her history and exam is unremarkable. Your next best action is to
- A.
Prescribe and ACE inhibitor
- B.
Have her return for a BP recheck in 1 week
- C.
Advise her that her current therapy is adequate
- D.
Start and alpha adrenergic antagonist
Correct Answer
A. Prescribe and ACE inhibitorExplanation
The patient is a 68-year-old woman with a history of hypertension, diabetes, and hyperlipidemia. Her blood pressure reading is 138/88, which is above the target range for patients with these comorbidities. Prescribing an ACE inhibitor would be the next best action as it is a recommended first-line medication for patients with hypertension and diabetes. ACE inhibitors have been shown to be effective in reducing blood pressure and preventing complications associated with hypertension. Therefore, prescribing an ACE inhibitor would help to better control the patient's blood pressure and reduce her risk of cardiovascular events.Rate this question:
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- 3.
You examine a 78-year-old woman with long-standing, poorly controlled hypertension. When evaluating her for hypertensive target organ damage, you look for evidence of:
- A.
Lipid abnormalities
- B.
Hyperinsulinemia and insulin resistance
- C.
Left ventricular hypertrophy
- D.
Clotting disorders
Correct Answer
C. Left ventricular hypertrophyExplanation
When evaluating a patient for hypertensive target organ damage, one of the key things to look for is evidence of left ventricular hypertrophy. This is because long-standing, poorly controlled hypertension can cause the heart muscle to thicken and enlarge in response to the increased workload. Left ventricular hypertrophy is associated with an increased risk of cardiovascular events such as heart failure, arrhythmias, and myocardial infarction. Therefore, identifying left ventricular hypertrophy in a patient with poorly controlled hypertension is important for assessing the extent of organ damage and determining appropriate management strategies.Rate this question:
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- 4.
Diagnostic testing for a patient with new stage 1 primary HTN diagnosis should include all of the following except:
- A.
Hct
- B.
Uric acid
- C.
Creatinine
- D.
Potassium
Correct Answer
B. Uric acidExplanation
When diagnosing a patient with new stage 1 primary hypertension, it is important to assess certain factors that could contribute to the condition. Hematocrit (Hct), creatinine, and potassium levels are all relevant indicators that can help determine the cause and severity of hypertension. Uric acid, on the other hand, is not directly related to hypertension and therefore would not be necessary to include in the diagnostic testing.Rate this question:
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- 5.
In the person with HTN, which of the following would likely yield the greatest potential reduction in BP in a patient with a BMI of 30?
- A.
10-kg weight loss
- B.
Dietary sodium restriction to 2.4 g per day
- C.
Regular aerobic physical activity, such as 30 minutes brisk walking most days
- D.
Moderate alcohol consumption
Correct Answer
A. 10-kg weight lossExplanation
Losing 10 kg of weight would likely yield the greatest potential reduction in blood pressure (BP) in a person with hypertension (HTN) and a BMI of 30. Obesity is a known risk factor for HTN, and weight loss can significantly lower BP. Losing 10 kg would result in a substantial reduction in body mass, leading to decreased strain on the cardiovascular system and improved overall health. Dietary sodium restriction, regular aerobic physical activity, and moderate alcohol consumption can also contribute to lowering BP, but the impact of weight loss is generally more significant.Rate this question:
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- 6.
Which of the following medications is a dihydropyridine calcium channel blocker?
- A.
Lisinopril
- B.
Verapamil
- C.
Amlodipine
- D.
Doxazosin
Correct Answer
C. AmlodipineExplanation
Amlodipine is a dihydropyridine calcium channel blocker. It works by blocking the calcium channels in the smooth muscles of blood vessels, causing them to relax and dilate. This helps to lower blood pressure and improve blood flow. Lisinopril is an ACE inhibitor, Verapamil is a non-dihydropyridine calcium channel blocker, and Doxazosin is an alpha-1 blocker. Therefore, Amlodipine is the correct answer as it belongs to the dihydropyridine class of calcium channel blockers.Rate this question:
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- 7.
Which of the following medications is a nondihydropyridine calcium channel blocker?
- A.
Lisinopril
- B.
Diltiazem
- C.
Amlodipine
- D.
Prazosin
Correct Answer
B. DiltiazemExplanation
Diltiazem is a nondihydropyridine calcium channel blocker. It works by blocking the movement of calcium ions into the smooth muscle cells of the heart and blood vessels, which helps to relax and widen the blood vessels, thus reducing blood pressure. Lisinopril is an ACE inhibitor, Amlodipine is a dihydropyridine calcium channel blocker, and Prazosin is an alpha-1 blocker. Therefore, the correct answer is Diltiazem.Rate this question:
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- 8.
Which of the following medications is an alpha-adrenergic antagonist?
- A.
Enalapril
- B.
Diltiazem
- C.
Felodipine
- D.
Doxazosin
Correct Answer
D. DoxazosinExplanation
Doxazosin is an alpha-adrenergic antagonist medication. It works by blocking the alpha-1 adrenergic receptors in the smooth muscles of the blood vessels and prostate. This causes relaxation of the blood vessels, leading to a decrease in blood pressure. It is commonly used to treat hypertension and benign prostatic hyperplasia. Enalapril, Diltiazem, and Felodipine are not alpha-adrenergic antagonists and have different mechanisms of action.Rate this question:
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- 9.
Which of the following medications is an ACEI
- A.
Trandolapril
- B.
Clonidine
- C.
Felodipine
- D.
Doxazosin
Correct Answer
A. TrandolaprilExplanation
Trandolapril is the correct answer because it belongs to the class of medications known as ACE inhibitors (ACEIs). ACE inhibitors work by blocking the action of an enzyme called angiotensin-converting enzyme (ACE), which helps to relax and widen blood vessels, reducing blood pressure. Clonidine, Felodipine, and Doxazosin are not ACE inhibitors but belong to different classes of medications used to treat hypertension.Rate this question:
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- 10.
Which of the following medications is an angiotensin receptor antagonist?
- A.
Trandolapril
- B.
Methyldopa
- C.
Telmisartan
- D.
Atenolol
Correct Answer
C. TelmisartanExplanation
Telmisartan is an angiotensin receptor antagonist. It works by blocking the action of angiotensin II, a hormone that causes blood vessels to narrow, thereby relaxing and widening the blood vessels. This helps to lower blood pressure and improve blood flow. Trandolapril is an ACE inhibitor, Methyldopa is a centrally acting alpha-2 adrenergic agonist, and Atenolol is a beta blocker, none of which are angiotensin receptor antagonists.Rate this question:
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- 11.
Which of the following medications is a beta-adrenergic receptor antagonist?
- A.
Clonidine
- B.
Spironolactone
- C.
HCTZ
- D.
Pindolol
Correct Answer
D. PindololExplanation
Pindolol is a beta-adrenergic receptor antagonist. Beta-adrenergic receptor antagonists, also known as beta-blockers, block the action of adrenaline and noradrenaline on beta receptors in the body. Pindolol specifically blocks both beta-1 and beta-2 adrenergic receptors, making it effective in treating conditions such as hypertension and angina. Clonidine is an alpha-2 adrenergic agonist used for hypertension, spironolactone is a potassium-sparing diuretic used for heart failure and hypertension, and HCTZ is a thiazide diuretic used for hypertension.Rate this question:
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- 12.
The mechanism of action of aliskiren (Tekturna) is as a/an:
- A.
ACEI
- B.
Beta-adrenergic antagonist
- C.
Centrally acting agent
- D.
Direct renin inhibitor
Correct Answer
D. Direct renin inhibitorExplanation
Aliskiren (Tekturna) is a direct renin inhibitor. Renin is an enzyme involved in the production of angiotensin II, which is a potent vasoconstrictor. By inhibiting renin, aliskiren reduces the production of angiotensin II, leading to vasodilation and decreased blood pressure. It is not an ACEI, beta-adrenergic antagonist, or centrally acting agent.Rate this question:
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- 13.
In obtaining an office BP measurement, which of the following is most reflective of the Seventh Report of the National High Blood Pressure Education Program for the Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC-7) recommendations?
- A.
Patient should sit in chair with feet flat on floor for at least 5 minutes before obtaining a reading
- B.
The BP cuff should not cover more than 50 % of the upper arm
- C.
The patient should sit on the edge of the examination table without arm support to enhance reading accuracy.
- D.
Obtaining the BP reading immediately after the patient walks into the exam room is recommended.
Correct Answer
A. Patient should sit in chair with feet flat on floor for at least 5 minutes before obtaining a readingExplanation
The correct answer is "Patient should sit in chair with feet flat on floor for at least 5 minutes before obtaining a reading." This is most reflective of the JNC-7 recommendations because it allows the patient to achieve a relaxed state and stabilize their blood pressure before the measurement is taken. This helps to ensure that the reading is accurate and representative of the patient's true blood pressure.Rate this question:
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- 14.
A BP elevation noted only at an office visit is commonly known as __________ hypertension
- A.
Provider-induced
- B.
Clinical
- C.
White coat
- D.
Pseudo
Correct Answer
C. White coatExplanation
White coat hypertension refers to a temporary increase in blood pressure that occurs when a person is in a medical setting, such as a doctor's office or hospital, but not in their everyday life. This phenomenon is believed to be caused by the anxiety or stress of being in a medical environment, leading to a falsely elevated blood pressure reading. It is important to recognize white coat hypertension to avoid unnecessary treatment with medication for hypertension when it is not actually present.Rate this question:
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- 15.
The most important goal of treating HTN is to:
- A.
Strive to reach recommended numeric BP measurement
- B.
Avoid disease-related target organ damage
- C.
Develop a plan of care with minimal adverse effects
- D.
Treat concomitant health problems often noted in the person with this condition
Correct Answer
B. Avoid disease-related target organ damageExplanation
The most important goal of treating HTN is to avoid disease-related target organ damage. This means that the primary objective of treating hypertension is to prevent damage to organs such as the heart, kidneys, brain, and blood vessels, which can occur as a result of high blood pressure. By effectively managing blood pressure levels, healthcare providers can reduce the risk of complications and improve overall health outcomes for individuals with hypertension. This goal takes precedence over other considerations such as reaching recommended numeric blood pressure measurements, developing a care plan with minimal adverse effects, and treating concomitant health problems.Rate this question:
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- 16.
You start a patient with hypertension who is already receiving an ACEI on sprionolactone. You advise the patient to return in 4 weeks to check which of the following lab parameters?
- A.
Sodium
- B.
Calcium
- C.
Potassium
- D.
Chloride
Correct Answer
C. PotassiumExplanation
When starting a patient with hypertension on spironolactone, it is important to monitor their potassium levels. Spironolactone is a potassium-sparing diuretic, meaning it helps the body retain potassium. However, if potassium levels become too high, it can lead to hyperkalemia, which can be dangerous. Therefore, it is crucial to regularly check the patient's potassium levels to ensure they are within a safe range. Monitoring other lab parameters such as sodium, calcium, and chloride may also be important, but the primary concern in this case is the patient's potassium levels.Rate this question:
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- 17.
A 68-year-old woman presents with HTN and a BP of 145-155 / 92-96 mmHG documented over 2 months on three different occasions. ECG and creatinine are normal, and she has no proteinuria. Clinical findings include the following: BMI 26.4; no S3, S4, or murmur; and point of maximal impulse at the 5th intercostal space, mid-clavicular line. Wich of the following represents the best intervention.
- A.
Initiate therapy with atenolol
- B.
Initiate therapy with HCTZ
- C.
Initiate therapy with methyldopa
- D.
Continue to monitor BP and start drug therapy if evidence of target organ damage.
Correct Answer
B. Initiate therapy with HCTZExplanation
The best intervention in this case is to initiate therapy with HCTZ (hydrochlorothiazide). This is because the patient has hypertension (HTN) with consistently elevated blood pressure readings over a period of time. HCTZ is a diuretic that helps lower blood pressure by reducing the volume of fluid in the body. Since the patient has no evidence of target organ damage and her ECG and creatinine are normal, starting with a diuretic like HCTZ is a reasonable first-line treatment option. Atenolol is a beta-blocker and methyldopa is an alpha-2 agonist, both of which can be considered as alternative options, but in this case, HCTZ is the best choice.Rate this question:
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- 18.
Which of the following can have a favorable effect on a comorbid condition in a person with HTN?
- A.
Chlorthalidone in gout
- B.
Propranolol with airway disease
- C.
Verapamil in migraine headaches
- D.
Methyldopa in an older adult
Correct Answer
C. Verapamil in migraine headachesExplanation
Verapamil is a calcium channel blocker that can be used to treat migraine headaches. Migraine headaches are a comorbid condition commonly seen in individuals with hypertension (HTN). Verapamil works by relaxing the blood vessels and reducing the frequency and severity of migraines. Therefore, using Verapamil to treat migraines in a person with HTN can have a favorable effect on their comorbid condition.Rate this question:
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- 19.
According to the recommendations found in JNC-7, all of the following medications are designated as having a compelling indication for use in the person with high cardiovascular disease risk except:
- A.
Doxazosin
- B.
HCTZ
- C.
Atenolol
- D.
Trandolapril
Correct Answer
A. DoxazosinExplanation
The correct answer is Doxazosin. According to the recommendations in JNC-7, all of the medications listed (HCTZ, Atenolol, and Trandolapril) are designated as having a compelling indication for use in individuals with high cardiovascular disease risk. However, Doxazosin is not specifically mentioned as having a compelling indication in this context.Rate this question:
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- 20.
You see a 59-year-old man with poorly controlled HTN. On physical exam, you note grade 1 hypertensive retinopathy. You anticipate all of the following will be present except:
- A.
Patient report of acute visual change
- B.
Narrowing of the terminal arterioles
- C.
Sharp optic disc borders
- D.
Absence of retinal hemorrhage
Correct Answer
A. Patient report of acute visual changeExplanation
The presence of grade 1 hypertensive retinopathy indicates mild changes in the blood vessels of the retina due to poorly controlled hypertension. Symptoms such as acute visual change are not typically associated with grade 1 hypertensive retinopathy. The narrowing of the terminal arterioles, sharp optic disc borders, and absence of retinal hemorrhage are commonly observed findings in grade 1 hypertensive retinopathy.Rate this question:
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- 21.
A 52-year-old woman whose BP is consistently 130-135 / 82-86 mmHG who is otherwise well is considered to have:
- A.
Normal BP
- B.
Prehypertension
- C.
Stage 1 HTN
- D.
Stage 2 HTN
Correct Answer
B. PrehypertensionExplanation
The given blood pressure readings of 130-135 / 82-86 mmHg fall within the prehypertension range. Prehypertension is a condition where blood pressure levels are higher than normal but not yet classified as hypertension. This condition serves as a warning sign that the individual is at risk of developing high blood pressure in the future. It is important for the woman to monitor her blood pressure regularly and make lifestyle changes to prevent the progression of prehypertension to hypertension.Rate this question:
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- 22.
Which medication(s) are listed as compelling indications for heart failure?
- A.
Thiazide Diuretic
- B.
Beta blocker
- C.
ACEI
- D.
ARB
- E.
Aldosterone antagonist
- F.
Calcium channel blocker
Correct Answer(s)
A. Thiazide Diuretic
B. Beta blocker
C. ACEI
D. ARB
E. Aldosterone antagonistExplanation
The medications listed as compelling indications for heart failure include Thiazide Diuretic, Beta blocker, ACEI, ARB, and Aldosterone antagonist. These medications are commonly prescribed to manage heart failure and have been shown to be effective in improving symptoms, reducing hospitalizations, and increasing survival rates in patients with heart failure. Thiazide diuretics help in reducing fluid buildup, beta blockers improve heart function, ACEIs and ARBs dilate blood vessels and reduce strain on the heart, and aldosterone antagonists help in reducing fluid retention. These medications target different aspects of heart failure and are often used in combination to provide optimal management for patients.Rate this question:
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- 23.
Which medication(s) are listed as compelling indications for Diabetes?
- A.
Thiazide diuretic
- B.
Beta blocker
- C.
ACEI
- D.
ARB
- E.
Aldosterone antagonist
- F.
Calcium channel blocker
Correct Answer(s)
A. Thiazide diuretic
B. Beta blocker
C. ACEI
D. ARB
F. Calcium channel blockerExplanation
The medications listed as compelling indications for Diabetes are Thiazide diuretic, Beta blocker, ACEI, ARB, and Calcium channel blocker. These medications are commonly prescribed to patients with diabetes to manage their blood pressure and prevent complications associated with the disease. Thiazide diuretics help reduce fluid buildup and lower blood pressure, beta blockers decrease heart rate and blood pressure, ACE inhibitors and ARBs relax blood vessels and lower blood pressure, and calcium channel blockers relax blood vessels and reduce the workload on the heart. By effectively managing blood pressure, these medications can help prevent cardiovascular events in patients with diabetes.Rate this question:
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- 24.
Which medication(s) are listed as compelling indications for Chronic renal disease?
- A.
Thiazide diuretic
- B.
Beta Blocker
- C.
ACEI
- D.
ARB
- E.
Aldosterone Antagonist
- F.
Calcium channel blocker
Correct Answer(s)
C. ACEI
D. ARBExplanation
ACE inhibitors (ACEI) and angiotensin receptor blockers (ARB) are listed as compelling indications for chronic renal disease. These medications are commonly prescribed to patients with chronic kidney disease (CKD) because they have been shown to slow down the progression of kidney damage and reduce proteinuria. ACE inhibitors and ARBs work by blocking the effects of angiotensin II, a hormone that constricts blood vessels and increases blood pressure. By blocking these effects, ACE inhibitors and ARBs help to lower blood pressure and reduce the strain on the kidneys, thus protecting them from further damage.Rate this question:
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- 25.
Which medication(s) are listed as compelling indications for high risk CAD?
- A.
Thiazide diuretic
- B.
Beta blocker
- C.
ACEI
- D.
ARB
- E.
Aldosterone antagonist
- F.
Calcium channel blocker
Correct Answer(s)
A. Thiazide diuretic
B. Beta blocker
C. ACEI
F. Calcium channel blockerExplanation
Thiazide diuretics, beta blockers, ACE inhibitors, and calcium channel blockers are all listed as compelling indications for high-risk CAD. These medications are commonly prescribed to patients with coronary artery disease (CAD) due to their proven efficacy in reducing the risk of cardiovascular events and improving outcomes. Thiazide diuretics help lower blood pressure and reduce fluid retention, beta blockers decrease heart rate and blood pressure, ACE inhibitors dilate blood vessels and improve blood flow, and calcium channel blockers relax and widen blood vessels. These medications are recommended based on evidence from clinical trials and guidelines for the management of CAD.Rate this question:
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- 26.
Which medication(s) are listed as compelling indications for after an MI?
- A.
Thiazide diuretic
- B.
Beta blocker
- C.
ACEI
- D.
ARB
- E.
Aldosterone antagonist
- F.
Calcium channel blocker
Correct Answer(s)
B. Beta blocker
C. ACEI
E. Aldosterone antagonistExplanation
After a myocardial infarction (MI), certain medications are recommended as compelling indications. Beta blockers are prescribed to reduce the workload on the heart and prevent future cardiac events. ACE inhibitors (ACEI) are used to lower blood pressure and protect the heart from further damage. Aldosterone antagonists are given to prevent fluid retention and reduce the risk of heart failure. Thiazide diuretics, ARBs, and calcium channel blockers are not specifically mentioned as compelling indications after an MI.Rate this question:
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- 27.
Which medication(s) are listed as compelling indications for Recurrent CVA?
- A.
Thiazide diuretic
- B.
Beta blocker
- C.
ACEI
- D.
ARB
- E.
Aldosterone Antagonist
- F.
Calcium channel blocker
Correct Answer(s)
A. Thiazide diuretic
C. ACEIExplanation
Thiazide diuretics and ACE inhibitors (ACEIs) are listed as compelling indications for recurrent CVA (cerebrovascular accident) because they have been shown to be effective in reducing the risk of stroke recurrence. Thiazide diuretics help lower blood pressure by removing excess fluid from the body, which can help prevent further damage to blood vessels in the brain. ACE inhibitors work by relaxing blood vessels and reducing the production of certain hormones that can contribute to stroke. Therefore, these medications are recommended for individuals with a history of recurrent CVA to help prevent future strokes.Rate this question:
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- 28.
You examine a 24-year-old woman with mitral valve prolapse. Her exam findings also may include:
- A.
Pectus excavatum
- B.
Obesity
- C.
Petite stature
- D.
Hyperextensible joints
Correct Answer
A. Pectus excavatumExplanation
Pectus excavatum is a condition where the breastbone sinks into the chest, creating a concave appearance. It is commonly seen in individuals with connective tissue disorders such as Marfan syndrome, which is associated with mitral valve prolapse. The presence of pectus excavatum in this 24-year-old woman suggests a possible underlying connective tissue disorder, which may be contributing to her mitral valve prolapse.Rate this question:
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- 29.
In performing a cardiac exam in a person with MVP, you expect to find:
- A.
Early to mid-systolic, crescendo-decrescendo murmur
- B.
A pansystolic murmur
- C.
A low-pitched, diastolic rumble
- D.
A mid to late systolic murmur
Correct Answer
D. A mid to late systolic murmurExplanation
In performing a cardiac exam in a person with MVP (mitral valve prolapse), a mid to late systolic murmur is expected. MVP is a condition where the mitral valve of the heart does not close properly, causing blood to leak back into the left atrium during systole. This results in a murmur that is heard in the mid to late part of systole when the blood is regurgitating through the valve. The murmur is typically described as a high-pitched, systolic click followed by a late systolic murmur.Rate this question:
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- 30.
Additional findings in MVP include:
- A.
An opening snap
- B.
A mid-systolic click
- C.
A paradoxical splitting of the second heart sound (S2)
- D.
A fourth heart sound (S4)
Correct Answer
B. A mid-systolic clickExplanation
The presence of a mid-systolic click is an additional finding in MVP. This click occurs during systole, specifically in the middle of systole, and is caused by the sudden tensing and bulging of the mitral valve leaflets into the left atrium. It is typically heard best at the apex and may be followed by a late systolic murmur. The mid-systolic click is a characteristic finding in MVP and is caused by the abnormal movement of the mitral valve.Rate this question:
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- 31.
Intervention for patients with MVP may include:
- A.
Restricted activity because of low cardiac output
- B.
Control of fluid intake to minimize risk of volume overload
- C.
Routine use of beta-adrenergic antagonists to control palpatations
- D.
Encouragement of a regular program for aerobic activity
Correct Answer
D. Encouragement of a regular program for aerobic activityExplanation
Encouragement of a regular program for aerobic activity is an appropriate intervention for patients with MVP because regular aerobic exercise can help improve cardiovascular fitness, strengthen the heart muscle, and promote overall cardiovascular health. It can also help reduce symptoms such as palpitations and improve overall well-being. However, it is important to note that the intensity and duration of exercise should be tailored to the individual's specific condition and limitations, and it is always recommended to consult with a healthcare professional before starting any exercise program.Rate this question:
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- 32.
When a heart valve fails to open to its normal orifice size, it is said to be:
- A.
Stenotic
- B.
Incompetent
- C.
Sclerotic
- D.
Regurgitant
Correct Answer
A. StenoticExplanation
When a heart valve fails to open to its normal orifice size, it is said to be stenotic. This means that the valve is narrowed or constricted, which restricts blood flow through the valve. This can lead to symptoms such as chest pain, shortness of breath, and fatigue. Stenosis can occur in any of the heart valves, including the aortic valve, mitral valve, tricuspid valve, and pulmonary valve. Treatment for stenotic valves may involve medication or surgical intervention to repair or replace the affected valve.Rate this question:
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- 33.
When a heart valve fails to close properly, it is said to be:
- A.
Stenotic
- B.
Incompetent
- C.
Sclerotic
- D.
Regurgitant
Correct Answer
B. IncompetentExplanation
When a heart valve fails to close properly, it is said to be incompetent. This means that the valve is unable to effectively prevent the backflow of blood, leading to regurgitation or leakage of blood in the opposite direction. This condition can result in symptoms such as shortness of breath, fatigue, and abnormal heart sounds. Treatment options may include medication or surgical repair/replacement of the valve.Rate this question:
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- 34.
You are evaluating a patient who has rheutmatic heart disease. When assessing her for mitral stenosis, you auscultate the heart, anticipating finding the following murmur:
- A.
Systolic with wide radiation over the precordium
- B.
Localized diastolic with little radiation
- C.
Diastolic with radiation to the neck
- D.
Systolic with radiation to the axilla
Correct Answer
B. Localized diastolic with little radiationExplanation
In patients with mitral stenosis, the narrowing of the mitral valve results in impaired blood flow from the left atrium to the left ventricle during diastole. This causes a diastolic murmur, which is heard during the filling phase of the cardiac cycle. The murmur is typically localized, meaning it is best heard at the apex of the heart and does not radiate widely. This is due to the restricted blood flow across the narrowed valve. Therefore, the correct answer is "Localized diastolic with little radiation."Rate this question:
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- 35.
In evaluating mitral valve incompetency, you expect to find the following murmur:
- A.
Systolic with radiation to the axilla
- B.
Diastolic with little radiation
- C.
Diastolic with radiation to the axilla
- D.
Localized systolic
Correct Answer
A. Systolic with radiation to the axillaExplanation
In mitral valve incompetency, the mitral valve does not close properly during systole, causing blood to leak back into the left atrium. This results in a regurgitant flow of blood from the left ventricle to the left atrium during systole, creating a systolic murmur. The radiation to the axilla indicates that the murmur is heard not only at the apex of the heart but also in the axillary region, which is characteristic of mitral valve incompetence.Rate this question:
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- 36.
In evaluating the person with aortic stenosis, the NP anticipates finding 12-lead ECG changes consistent with:
- A.
Right bundle branch block
- B.
Extreme axis deviation
- C.
Right atrial enlargement
- D.
Left ventricular hypertrophy
Correct Answer
D. Left ventricular hypertrophyExplanation
The NP anticipates finding 12-lead ECG changes consistent with left ventricular hypertrophy in a person with aortic stenosis. Aortic stenosis is a condition characterized by the narrowing of the aortic valve, which leads to increased pressure and workload on the left ventricle. Over time, this can cause the left ventricle to become hypertrophied, or thicker, as it tries to pump blood against the narrowed valve. These changes can be detected on an ECG, such as increased voltage amplitudes in the left ventricular leads and repolarization abnormalities.Rate this question:
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- 37.
Of the following patients, who is in greatest need of endocarditis prophylaxis when planning dental work?
- A.
22-year-old woman with MVP with trace mitral regurgitation noted on ECHO
- B.
54-year-old woman with a prosthetic aortic valve
- C.
66-year-old man with cardiomyopathy
- D.
58-year-old woman who had a 3-vessel CABG with drug-eluting stents 1 year ago
Correct Answer
B. 54-year-old woman with a prosthetic aortic valveExplanation
Patients with prosthetic heart valves are at the highest risk for developing infective endocarditis. Therefore, the 54-year-old woman with a prosthetic aortic valve is in the greatest need of endocarditis prophylaxis when planning dental work.Rate this question:
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- 38.
Of the following people, who has no significant increased risk for developing bacterial endocarditis?
- A.
43-year-old woman with bicuspid aortic valve
- B.
55-year-old man who was diagnosed with a Still's murmur as a child
- C.
45-year-old woman with a history of endocarditis
- D.
75-year-old man with dilated cardiomyopathy
Correct Answer
B. 55-year-old man who was diagnosed with a Still's murmur as a childExplanation
A Still's murmur is a benign innocent heart murmur that is commonly heard in children and usually disappears by adulthood. It is not associated with any structural abnormalities or increased risk for developing bacterial endocarditis. Therefore, the 55-year-old man who was diagnosed with a Still's murmur as a child has no significant increased risk for developing bacterial endocarditis.Rate this question:
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- 39.
You are examining an elderly woman and find a grade 3/6 crescendo-decrescendo systolic murmur with radiation to the neck. This is most likely caused by:
- A.
Aortic stenosis
- B.
Aortic regurgitation
- C.
Anemia
- D.
Mitral stenosis
Correct Answer
A. Aortic stenosisExplanation
A grade 3/6 crescendo-decrescendo systolic murmur with radiation to the neck is characteristic of aortic stenosis. Aortic stenosis is the narrowing of the aortic valve, which obstructs the flow of blood from the left ventricle to the aorta. This causes the blood to flow through the narrowed valve with increased velocity, resulting in a murmur. The crescendo-decrescendo pattern indicates the turbulent blood flow through the stenotic valve. The radiation to the neck suggests that the murmur is audible in the carotid arteries, which are located in the neck.Rate this question:
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- 40.
Aortic stenosis in a 15-year-old is most likely:
- A.
A sequela of rheumatic fever
- B.
A result of congenital defect
- C.
Calcific in nature
- D.
Found with atrial septal defect
Correct Answer
B. A result of congenital defectExplanation
Aortic stenosis in a 15-year-old is most likely a result of a congenital defect. This means that the individual was born with a narrowed aortic valve, which restricts blood flow from the left ventricle to the aorta. It is less likely to be a sequela of rheumatic fever, which is an inflammatory condition that can cause damage to the heart valves. Calcific aortic stenosis typically occurs in older individuals due to the buildup of calcium deposits on the valve leaflets. There is no mention of an atrial septal defect in the question, so it is not relevant to the most likely cause of aortic stenosis in this case.Rate this question:
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- 41.
A physiological murmur has which of the following characteristics?
- A.
Occurs late in systole
- B.
Is noted in a localized area of auscultation
- C.
Becomes softer when the patient moves from supine to standing
- D.
Frequently obliterates S2
Correct Answer
C. Becomes softer when the patient moves from supine to standingExplanation
A physiological murmur is a normal sound heard during the cardiac cycle. It is typically heard in early systole and is not associated with any underlying heart condition. It is usually heard in a widespread area of auscultation, rather than localized. Additionally, a physiological murmur does not typically affect the sound of the second heart sound (S2). However, it may become softer when the patient changes position from supine to standing due to changes in blood flow dynamics.Rate this question:
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- 42.
You are examining an 18-year-old man who is seeking a sports clearance physical exam. You note a mid-systolic murmur that gets louder as he stands. This may represent:
- A.
Aortic stenosis
- B.
Hypertrophic cardiomyopathy
- C.
A physiologic murmur
- D.
A Still's murmur
Correct Answer
B. Hypertrophic cardiomyopathyExplanation
The presence of a mid-systolic murmur that gets louder as the patient stands suggests hypertrophic cardiomyopathy. This condition is characterized by the thickening of the heart muscle, which can obstruct blood flow and cause turbulent blood flow, resulting in a murmur. The murmur typically intensifies with maneuvers that decrease left ventricular volume, such as standing up. Aortic stenosis, on the other hand, would typically cause a systolic ejection murmur that radiates to the neck, and it would not be affected by changes in position. A physiologic murmur is usually innocent and does not change with position. Still's murmur is a benign murmur commonly heard in children and is not associated with changes in position.Rate this question:
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- 43.
According to the AHA, which of the following antibiotics should be used for endocarditis prophylaxis in patients who are allergic to PCN?
- A.
Erythromycin
- B.
Dicloxacillin
- C.
Azithromycin
- D.
Ofloxacin
Correct Answer
C. AzithromycinExplanation
Azithromycin should be used for endocarditis prophylaxis in patients who are allergic to PCN because it is a macrolide antibiotic that is effective against the bacteria that commonly cause endocarditis. Macrolides are considered an alternative to penicillin for prophylaxis in patients with PCN allergy. Erythromycin is also a macrolide antibiotic, but it is not the preferred choice due to its higher incidence of gastrointestinal side effects. Dicloxacillin is a penicillin antibiotic and should not be used in patients with PCN allergy. Ofloxacin is a fluoroquinolone antibiotic and is not recommended for endocarditis prophylaxis.Rate this question:
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- 44.
A grade III systolic murmur is usually:
- A.
Softer than the S2 heart sound
- B.
About as loud as the S1 heart sound
- C.
Accompanied by a thrill
- D.
Heard across the precordium but without radiation
Correct Answer
B. About as loud as the S1 heart soundExplanation
A grade III systolic murmur is usually about as loud as the S1 heart sound. This means that the intensity of the murmur is similar to the intensity of the first heart sound, which is the normal sound produced by the closing of the mitral and tricuspid valves. This suggests that the murmur is moderately loud and can be easily heard with a stethoscope. The other options, such as being softer than the S2 heart sound, accompanied by a thrill, or heard across the precordium without radiation, are not characteristics typically associated with a grade III systolic murmur.Rate this question:
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- 45.
The S3 heart sound has all of the following characteristics except:
- A.
Heard in early diastole
- B.
A presystolic sound
- C.
Noted in the presence of ventricular overload
- D.
Heard best with the bell of the stethoscope
Correct Answer
B. A presystolic soundExplanation
The S3 heart sound is a low-pitched sound that occurs in early diastole, after the S2 heart sound. It is associated with ventricular overload, such as in conditions like heart failure. The S3 sound is best heard with the bell of the stethoscope placed over the apex of the heart. Therefore, the correct answer is "A presystolic sound" because the S3 sound occurs in early diastole, not during the presystolic phase of the cardiac cycle.Rate this question:
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- 46.
The S4 heart sound has which of the following characteristics?
- A.
After it is initially noted, it is a permanent finding
- B.
It is noted in presence of poorly controlled HTN
- C.
It is heard best in early diastole
- D.
It is a high-pitched sound best heard with the diaphragm of the stethoscope
Correct Answer
B. It is noted in presence of poorly controlled HTNExplanation
The S4 heart sound is a low-pitched sound that occurs late in diastole, just before the S1 heart sound. It is caused by the contraction of the atria against a stiff or hypertrophic ventricle, indicating decreased ventricular compliance. This sound is commonly heard in patients with poorly controlled hypertension (HTN), as chronic HTN can lead to ventricular hypertrophy and decreased ventricular compliance. Therefore, the correct answer is "It is noted in the presence of poorly controlled HTN."Rate this question:
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- 47.
Of the following individuals, who is most likely to have a physiological split S2 heart sound?
- A.
19-year-old healthy athlete
- B.
49-year-old with well-controlled HTN
- C.
68-year-old stable heart failure
- D.
78-year-old with cardiomyopathy
Correct Answer
A. 19-year-old healthy athleteExplanation
A physiological split S2 heart sound refers to a normal variation in the timing of the closing of the aortic and pulmonic valves, resulting in a split sound. This is commonly observed in young and healthy individuals, particularly athletes, due to their increased cardiac output and enhanced cardiovascular conditioning. Therefore, the 19-year-old healthy athlete is most likely to have a physiological split S2 heart sound.Rate this question:
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- 48.
Causes of unstable angina include all of the following except:
- A.
Ventricular hypertrophy
- B.
Vasoconstriction
- C.
Nonocclusive thrombus
- D.
Inflammation or infection
Correct Answer
A. Ventricular hypertrophyExplanation
Unstable angina is characterized by chest pain or discomfort that occurs at rest or with minimal exertion and is caused by reduced blood flow to the heart. The causes of unstable angina include vasoconstriction (narrowing of blood vessels), nonocclusive thrombus (partial blockage of blood vessels), and inflammation or infection. However, ventricular hypertrophy, which refers to the thickening of the heart muscle, is not typically associated with unstable angina. Ventricular hypertrophy is usually a result of conditions such as high blood pressure or heart valve disease, and it may lead to other cardiac complications, but it is not directly linked to unstable angina.Rate this question:
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- 49.
Which of the following is most consistent with a person presenting with unstable angina?
- A.
A 5-minute episode of chest tightness brought on by stair climbing and relieved by rest.
- B.
A severe, searing pain that penetrates the chest and lasts about 30 seconds
- C.
Chest pressure lasting 20 minutes that occurs at rest
- D.
"heartburn" relieved by position change
Correct Answer
C. Chest pressure lasting 20 minutes that occurs at restExplanation
A person presenting with unstable angina may experience chest pressure that lasts for a longer duration (20 minutes) and occurs at rest. Unstable angina is characterized by chest pain or discomfort that is unpredictable, occurs at rest or with minimal exertion, and is more severe and prolonged compared to stable angina. The fact that the chest pressure lasts for 20 minutes and occurs at rest suggests that it is consistent with unstable angina.Rate this question:
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- 50.
In assessing a woman with or at risk for acute coronary syndrome (ACS), the NP considers that the patient will likely present:
- A.
In a manner similar to that of a man with equivalent disease
- B.
At the same age as a man with similar health problems.
- C.
More commonly with angina and less commonly with acute MI
- D.
Less commonly with HF
Correct Answer
C. More commonly with angina and less commonly with acute MIExplanation
Women with acute coronary syndrome (ACS) are more likely to present with angina, which is chest pain or discomfort, compared to men. This is because women tend to have more atypical symptoms of ACS, such as shortness of breath, fatigue, or nausea, rather than the typical symptom of chest pain. On the other hand, men are more likely to present with acute myocardial infarction (MI), which is a heart attack. Women also have a lower incidence of heart failure (HF) compared to men. Therefore, it is more common for women with or at risk for ACS to present with angina and less commonly with acute MI or HF.Rate this question:
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Mar 21, 2023Quiz Edited by
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