g term? Metoprolol A patient taking an ACE inhibitor should avoid: potassium supplements. An 87-year-old has history of symptomatic heart failure. He presents today with lower extremity edema and mild shortness of breath with exertion. In addition to a diuretic for volume overload, what other medication should he receive today? ACE inhibitor A 42-year-old hypertensive patient was given a thiazide diuretic 4 weeks ago for treatment of primary hypertension. On his return visit today, he reports feeling weak and tired. What should the NP consider to evaluate the weakness and fatigue? Potassium level Which class of medication is frequently used to improve long- term outcomes in patients with systolic dysfunction? ACE inhibitors Orthostatic hypotension can be diagnosed in an older adult if the systolic blood pressure decreases: more than 20 points within 3 minutes after rising. A 74-year-old patient has peripheral artery disease (PAD). Which item listed below is an important nonmodifiable risk factor for PAD? Diabetes The lipid particle with the greatest atherogenic effect is: LDL. Which medication could potentially exacerbate heart failure (HF)? Naproxen Where would the murmur associated with mitral regurgitation best be auscultated? Mitral listening point A 43-year-old Hispanic male has an audible diastolic murmur best heard in the mitral listening point. There is no audible click. His status has been monitored for the past 2 years. This murmur is probably: mitral stenosis. An independent 82-year-old male patient is very active but retired last year. His total cholesterol and LDLs are moderately elevated. How should the NP approach his lipid elevation? Treatment is based on expected length of life A patient who has diabetes presents with pain in his lower legs when he walks and pain resolution with rest. When specifically asked about the pain in his lower leg, he likely will report pain: in the calf muscle. A 75-year-old patient with longstanding hypertension takes an ACE inhibitor and a thiazide diuretic daily. He has developed development of heart failure (HF). dyspnea on exertion and peripheral edema over the past several days. This probably indicates: An ACE inhibitor is specifically indicated in patients who have: hypertension, diabetes with proteinuria, heart failure. The correlation between blood pressure and age greater than 60 years is that as age increases: diastolic blood pressure decreases. A 77-year-old patient has had an increase in blood pressure since the last exam. The blood pressure readings are provided. If medication is to be started on this patient, what would be a good first choice? Calcium channel blocker Mrs. Brandy is having contrast dye next week for a heart catheterization. What drug does NOT need to be stopped prior to her catheterization? Losartan Older adults have a unique blood pressure pattern. Which blood pressure reading below reflects this pattern? 160/60 mmHg A 91-year-old female with longstanding history of chronic heart failure has renal and liver studies that have slowly worsened over the past year. This probably indicates: target organ damage secondary to heart failure. The usual clinical course of mitral valve prolapse: is benign. Which antibiotic should be used with caution if an older patient has cardiac conduction issues? Ciprofloxacin A patient with aortic stenosis has been asymptomatic for decades. On routine exam, he states that he has had some dizziness associated with activity but no chest pain or shortness of breath. The best course of action for the nurse practitioner is to: refer to cardiology. The nurse practitioner is caring for an independent 74-year-old female who had acute coronary syndrome (ACS) about 6 weeks ago. What medications should be part of her regimen unless there is a contraindication? ACE, ASA, beta blocker, and statin Which hypertensive patient is most likely to have adverse blood pressure effects from excessive sodium consumption? 70-year-old African American male A common side effect of thiazide diuretics is: erectile dysfunction. The carotid arteries are auscultated for bruits because: this is indicative of generalized atherosclerosis. Which choice below would be the best choice for an 80-year-old patient whose blood pressure is 172/72 mm Hg? Amlodipine Which item below represents the best choice of antihypertensive agents for the indicated patient? Lisinopril in a 35-year-old Caucasian male A patient with hypertension has been diagnosed with gout. Which home medication may have contributed to this episode of gout? Furosemide You are managing the warfarin dose for an older adult with a prosthetic heart valve. Which situation listed requires that warfarin be discontinued now? INR of 8, no significant bleeding Which of the following medications may have an unfavorable effect on a hypertensive patient's blood pressure? Naproxen Which study would be most helpful in evaluating the degree of hypertrophy of the atrium or ventricle? Echocardiography A patient has had poorly controlled hypertension for more than 10 years. Indicate the most likely position of his point of maximal impulse (PMI): 5th ICS, left of MCL. Drugs that target the renin-angiotensin-aldosterone system are particularly beneficial in patients who have: diabetic nephropathy. A patient taking atorvastatin for newly diagnosed dyslipidemia complains of fatigue, weakness, and muscle aches in his lower back, arms, and legs for the past three days. It has not improved with rest. How should this be evaluated? Stop the atorvastatin immediately. How often should lipids be screened in patients who are 65 years and older if they have lipid disorders or cardiovascular risk factors? Annually A patient who takes HCTZ 25 mg daily has complaints of muscle cramps. He probably has: hypokalemia. An older adult has renal insufficiency, hypertension, osteoarthritis, hypothyroidism, and varicose veins. Which medication should be avoided? NSAIDs An immune response to Group A Streptococcal infections involving the heart is: rheumatic fever. Warfarin treatment is greatly influenced by a patient's food and medication intake. Which group listed can potentially decrease INR (International Normalized Ratio) in an outpatient who takes warfarin? Sucralfate and cholestyramine A patient with newly diagnosed heart failure has started fosinopril in the last few days. She has developed a cough. What clinical finding can help distinguish the etiology of the cough as heart failure and not related to fosinopril? It is wet and worse with recumbence. You have been asked to evaluate a heart murmur in a pregnant patient. Can a 3D echocardiogram be safely used to evaluate her? Yes, this is perfectly safe. A patient with hypertension describes a previous allergic reaction to a sulfa antibiotic as "sloughing of skin" and hospitalization. Which medication is contraindicated in this patient? Hydrochlorothiazide In older adults, the three most common ailments are: hearing loss, hypertension, arthritis. The major difference between varicose veins and arteriosclerosis is the: vessels affected. A patient with mitral regurgitation (MR) has developed the most common arrhythmia associated with MR. The intervention most likely to prevent complications from this arrhythmia is: anticoagulation. A patient taking an angiotensin receptor blocker (ARB) should avoid: potassium supplements. Mr. Brown a 45-year-old African American male has the following lab values. What should the nurse practitioner do next? A thyroid stimulating hormone (TSH) level Which choice below characterizes a patient who has aortic regurgitation? Long asymptomatic period followed by exercise intolerance, then dyspnea at rest Pharmacologic treatment for older adults with hypertension should be initiated: for any type of hypertension. The most common indicator of end-organ damage in adolescents with hypertension is: left ventricular hypertrophy. A decrease in blood pressure can occur in men who take sildenafil (Viagra) and: any antihypertensive medication. A 75-year-old patient with longstanding hypertension takes a combination ACE inhibitor/thiazide diuretic and amlodipine daily. Today his diastolic blood pressure and heart rate are elevated. He has developed dyspnea on exertion and peripheral edema over the past several days. These symptoms likely demonstrate: development of heart failure. Tables are used for determination of maximum blood pressure values for adolescents. How are these blood pressure values established for adolescents? Height percentile, gender, and age Which group of medications would be detrimental if used to treat a patient who has heart failure (HF)? Fosinopril, HCTZ, verapamil Mr. Holbrook, a 75-year-old male, is a former smoker with a 30 pack-year history. He has come in today for an annual exam. He walks daily for 25 minutes, has had intentional weight loss, and has a near normal BMI. On examination, the patient is noted to This might indicate disease in the lower extremities. have an absence of hair growth on his lower legs. Which statement is true regarding this patient? Which test listed below may be used to exclude a secondary cause of hyperlipidemia in a patient who has elevated lipids? TSH An overweight 76-year-old female with a recent onset of diabetes has longstanding hypertension and hyperlipidemia. She has developed atrial fibrillation. The nurse practitioner knows that this patient is at risk for: heart failure (HF). A medication that may produce exercise intolerance in a patient who has hypertension is: metoprolol. A patient has shortness of breath. If heart failure is the etiology, which test demonstrates the highest sensitivity in diagnosing this? B type natriuretic peptide (BNP) According to the National Heart, Lung and Blood Institute, which characteristic listed below is a coronary heart disease (CHD) risk equivalent; that is, which risk factor places the patient at a CHD risk similar to a history of CHD? Diabetes mellitus A 75-year-old patient who has aortic stenosis wants to know what symptoms indicate worsening of his stenosis. The nurse practitioner replies: shortness of breath and syncope. A 55-year-old male is obese, does not exercise, and has hyperlipidemia. His average blood pressure is 150/90 mmHg. How should he be managed today? Lifestyle modifications are appropriate. A patient will be screened for hyperlipidemia via a serum specimen. He should be told: to fast for 12-14 hours. Which patient is most likely to have mitral valve prolapse? A 30-year-old female with no cardiac history A 40-year-old African American patient has blood pressure readings of 175/100 mmHg and 170/102 mmHg. What is a reasonable plan of care for this patient today? Initiate 5 mg amlodipine daily (usual dose is 5-10 mg daily). Besides hypertension, which risk factor most contributes to development of an abdominal aortic aneurysm? Cigarette smoking A 50-year-old patient with hypertension has taken hydrochlorothiazide 25 mg daily for the past 4 weeks. How should the nurse practitioner proceed? Add a drug from another class to the daily 25 mg hydrochlorothiazide. Three of the following medications warrant monitoring of potassium levels. Which one does NOT? Amlodipine The most common arrhythmia resulting from valvular heart disease is: atrial fibrillation. Classic symptoms of deep vein thrombosis (DVT) include: swelling, pain, and discoloration in lower extremity. A 65-year-old male patient has the following lipid levels. What class of medications is preferred to normalize his lipid levels and reduce his risk of a cardiac event? HMG CoA reductase inhibitors A 28-year-old has a Grade 3 murmur. Which characteristic indicates a need for referral? A fixed split Which mitral disorder results from redundancy of the mitral valve's leaflets? Mitral valve prolapse Mr. Smith is a 72-year-old patient who takes warfarin for chronic atrial fibrillation. His INR and CBC results are provided. The nurse practitioner should: stop the warfarin today and repeat the INR tomorrow. In order to reduce lipid levels, statins are most beneficial when taken: in conjunction with diet and exercise. A child's resting heart rate is expected to be between 60 and 100 beats per minute once he reaches: 10 years of age. An older adult who has hypertension and angina takes multiple medications. Which one of the following decreases the likelihood of his having angina? Beta blocker At what age should initial blood pressure screening take place? 3 years Which patient could be expected to have the highest systolic blood pressure? A 75-year-old male An older adult who has hypertension also has osteoporosis. Which antihypertensive agent would have the secondary effect of improving her osteoporosis? A thiazide diuretic Mr. Daigle is an 80-year-old patient who takes warfarin for chronic atrial fibrillation. The nurse practitioner should: stop warfarin for the next two days and repeat the INR on day 3. A common, early finding in patients who have chronic aortic regurgitation (AR) is: an hypertrophied left ventricle. A nurse practitioner has not increased the dosage of an antihypertensive medication even though the patient's blood pressure has remained 140/90 mmHg. This might be described as: clinical inertia. How often should blood pressure be measured in a child who is 3 years old? It should be measured annually. Risk assessment for dyslipidemia should begin at: 2 years. Ramipril has been initiated at a low dose in a patient with heart failure. What is most important to monitor in about 1 week? Potassium level An 80-year-old patient with longstanding hypertension takes Monopril and HCTZ for hypertension. His most recent blood pressures are listed. What should be done about his blood pressure? Add a calcium channel blocker A patient taking candesartan for treatment of hypertension should avoid: potassium supplements. Pharmacologic treatment for children who have hypertension should be initiated for: diabetics with hypertension. Many factors can contribute to the risk of congenital heart disease. Which maternal disease carries a higher risk of transposition of the great vessels (TGA), ventricular septal defect (VSD), and hypertrophic cardiomyopathy? Diabetes Which test below is most cost-effective to screen for abdominal aortic aneurysm? Abdominal ultrasound A patient with poorly controlled hypertension and history of myocardial infarction 6 years ago presents today with mild shortness of breath. He takes quinapril, ASA, metoprolol, and a statin daily. What symptom is NOT indicative of heart failure? Headache A patient who has mitral valve prolapse (MVP) reports chest pain and frequent arrhythmias. In the absence of other underlying cardiac anomalies, the drug of choice to treat her symptoms is: metoprolol. A 25-year-old patient has aortic stenosis (AS). The etiology of his AS is probably: congenital. A young child has an audible murmur. The nurse practitioner describes it as a grade 4 murmur. How should this be managed? The child should be referred to cardiology. A characteristic of an ACE inhibitor-induced cough is that it: usually begins within 2 weeks of starting therapy. The valve most commonly involved in chronic rheumatic heart disease is the: mitral. A 75-year-old has isolated systolic hypertension. She started on amlodipine 4 weeks ago. She states that since then, she has developed urinary incontinence. What is the nurse practitioner's assessment? It is probably related to amlodipine. It is probably related to amlodipine. Most hypertension in preadolescents and children is: secondary hypertension.