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Apea FNP CARDIO Exam (Best Revision
Material Updated April 2023) (Actual
Exam Questions, Answers and
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A common lab findings with ACE Inhibitors -------- Correct Answer --------- Increase K+ ACE inhibitor = retention of potassium. Measure potassium one month after starting and one month after changing a dose What should you do? Pt on Monopril and HCTZ for hypertension. His blood pressure is 160 - 170/92- 98 on several blood pressure checks ? Would you add an ARB? -------- Correct Answer -------- If these are at maximum doses, consideration should be given to adding a medication from a different class. CALCIUM CHANNEL BLOCKER NOT ARB - Adding an ARB may result in a precipitous decrease in his blood pressure because he takes an ACE inhibitor and both of these medications work in the renin- angiotensin-aldosterone system. Significance of sildenafil and any blood pressure meds -------- Correct Answer ---------Any antihypertensive medication ..... could have an additive effect with sildenafil (or another medication in this A specific drug-drug interaction to be aware of is the one that can occur with sildenafil and alpha blockers like tamsulosin, alfuzosin, prazosin, doxazosin, or terazosin. This combination of medications may increase the risk of symptomatic hypotension because the effect of these two drugs is additive -------- Correct Answer -------- Consider two meds low dose HCTZ and ARB or ace This patient's blood pressure goal is < 140/90 according to JNC VIII. Since he is more than 20 points above systolic goal (or greater than 10 points above diastolic goal) it is reasonable to consider two medications Risk assessment for dyslipidemia- what age to start assessment ----------Correct Answer ------- Start at age 2
Dyslipidemia assessment does not necessarily mean a Dyslipidemia assessment refers to assessing family history of dyslipidemia, premature cardiovascular disease, or diabetes, body mass index > 85% for age and sex, or history of other systemic diseases like Kawasaki Disease or treatment, or renal disease. When to start lipid profiles -------- Correct Answer -------- recommended between 18 and 21 years of age. A patient taking an ACE inhibitor should avoid: -------- Correct Answer -------- No K supplements ACE inhibitor potentially can produce hyperkalemia because its mechanism of action is in the renin-angiotensin-aldosterone system where potassium is spared. If potassium is taken in the form of potassium supplements, the effect will be additive and the risk of hyperkalemia can be great. An 80 year-old female who is otherwise well, has a blood pressure of 176/80. How should she be managed pharmacologically? -------- Correct Answer -------- CCB This patient has isolated systolic hypertension (ISH). This is common in older adults and is associated with tragic cardiac and cerebrovascular events. The drug class of choice to treat these patients is a long-acting calcium channel blocker. The class of calcium channel blockers recommended for ISH has the suffix "pine" (amlodipine, felodipine, etc). Remember ISH = PINE ACE inhibitor is specifically indicated in patients who have .. ---------- Correct Answer ------- hypertension, diabetes with proteinuria, heart failure. 77 year-old patient has had an increase in blood pressure since the last exam. The blood pressure has risen to 168/88 with 2 readings. The last exam's reading was 144/90. If medication is to be started on this patient, what would be a good first choice? -------- Correct Answer ---------CCB This patient is 77 years old and should have a goal blood pressure of < 150/90. A thiazide diuretic is not a good first choice in this patient because it will not be potent enough to decrease blood pressure by 25 points to get him to goal. A long acting calcium channel blocker is appropriate for patients with isolated systolic hypertension and will be more likely to get this patient to goal pressure than HCTZ. Beta-blockers are no longer recommended first line for uncomplicated hypertension. ACE inhibitors are very effective in patients who are high renin producers. Elderly patients tend to produce lower amounts of renin. A 63 year-old male has been your patient for several years. He is a former smoker who takes simvastatin, ramipril, and an aspirin daily. His blood pressure and lipids are well controlled. He presents to your clinic with complaints of fatigue and "just not feeling
This patient takes medications from 2 different classes of antihypertensives. If these are at maximum doses, consideration should be given to adding a medication from a different class. Adding an ARB may result in a precipitous decrease in his blood pressure because he takes an ACE inhibitor and both of these medications work in the renin-angiotensin-aldosterone system. Adding another diuretic will likely produce hypokalemia with a small decrease in blood pressure. The calcium channel blocker is a good choice because it will have an additive effect with the other medications he is taking. A beta blocker will slow the heart rate, not a preferred outcome in an elderly patient unless he has underlying angina or a heart rate problem. A 55 year-old male is obese, does not exercise, and has hyperlipidemia. His average blood pressure is 150/90. How should he be managed? He should be given low dose thiazide diuretic. An ACE inhibitor is appropriate. Lifestyle modifications are appropriate. He should receive an ACE inhibitor and thiazide diuretic. -------- Correct Answer ------- LIFESTYLE MODIFICATIONS According to JNC VIII, a patient who is diagnosed with hypertension should have lifestyle modifications initiated today. He has several modifiable risk factors. Management of these can be expected to decrease blood pressure. If his blood pressure is not within normal range (< 140/90) after 3 months, it is reasonable to consider a medication like an ACE, ARB, thiazide diuretic, or calcium channel blocker. 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 and around the ankle joint. in the calf muscle. radiating down his leg from the thigh. pain in his lower leg which waxes and wanes. -------- Correct Answer -------- in the calf muscle This patient's symptoms are typical of arteriosclerosis. The term for this symptom is intermittent claudication. When there is compromised arterial blood flow in the lower legs, a common complaint is reproducible pain in a specific group of muscles. The pain occurs because there is an incongruence between blood supply and demand. This produces pain that causes a patient to stop exercising in order to obtain relief of pain. A patient with 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 a(n):
ACE inhibitor. beta blocker. calcium channel blocker. diuretic. -------- Correct Answer -------- BETA BLOCKER Beta blockers are recommended to alleviate atrial or ventricular arrhythmias associated with mitral valve prolapse The valve most commonly involved in chronic rheumatic heart disease is the: aortic. mitral. pulmonic. tricuspid. -------- Correct Answer --------- MITRAL The mitral valve has a propensity for disorders secondary to rheumatic heart disease. Rarely is the pulmonic valve involved, but the aortic and tricuspid valves follow in descending order of involvement. Following an episode of rheumatic fever, which occurs infrequently in the US today but is common in developing countries, the valves can become stenotic or regurgitant. This is a major cause of valvular disease in the US seen primarily in immigrants A decrease in blood pressure can occur in men who take sildenafil and: amlodipine. tamsulosin. metoprolol. any antihypertensive medication. -------- Correct Answer ---------ANY B/P MED Any antihypertensive medication could have an additive effect with sildenafil (or another medication in this class). Caution is advised and should only be used if the male has stable blood pressure. A specific drug-drug interaction to be aware of is the one that can occur with sildenafil and alpha blockers like tamsulosin, alfuzosin, prazosin, doxazosin, or terazosin. This combination of medications may increase the risk of symptomatic hypotension because the effect of these two drugs is additive. IE ALPHA BLOCKERS ARE COREG AND LABETALOL ARE BOTH ALPHA AND BETA BLOCKERS Which choice below characterizes a patient with aortic regurgitation? Long asymptomatic period followed by exercise intolerance, then dyspnea at rest An acute onset of shortness of breath in the fifth or sixth decade
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Naproxen Furosemide Metformin Losartan -------- Correct Answer -------- LOSARTAN Naproxen and furosemide should be stopped for 24 hours prior to the catheterization. Metformin should be stopped 48 hours prior to the catheterization. Furosemide is stopped because it contributes to volume depletion. NSAIDs like naproxen are withheld because of the impact on renal prostaglandin production. Metformin has been implicated in lactic acidosis when combined with contrast dye in an impaired kidney. WHAT MEDS AFTER AN MI -------- Correct Answer -------- ACE, ASA, BB, STATIN After a myocardial event, an aspirin, ACE inhibitor, beta-blocker, and statin should be taken daily. The goal for statin dose is LDL measurement of less than 70 - 100 mg/dL. The aspirin will provide anticoagulation, and the ACE inhibitor and beta-blocker are associated with reduced morbidity and mortality if given soon after ACS. Niacin can: decrease total cholesterol and triglycerides. decrease serum glucose and LDLs. cause flushing and hypertension. increase liver enzymes -------- Correct Answer -------- INCREASE LFT Niacin can be used to decrease total cholesterol, LDLs, and increase HDLs. However its cardiovascular benefit is questionable although it improves lipid profiles. Liver function studies should be monitored prior to, with dosage increases, and periodically during consumption of niacin because elevations can occur. Glucose levels should be monitored as well because glucose levels can increase slightly in some patients who take niacin. Monitor for myalgias and rhabdomyolysis as with the statins. Niacin commonly causes flushing in patients, but, not hypertension NIACIN= DECREASE TC AND LDL INCREASE HDL-- PLUS GLUCOSE ALITTLE INCREASE LFT, MONITOR MYALGIA AND RHABDOMYOLYSIS WITH STATIN Pharmacologic treatment for very elderly adults with hypertension should be initiated: only if there is a life expectancy of 10 years or more. for any type of hypertension. without regard to lifestyle modifications. only for those who are symptomatic. -------- Correct Answer -------- ANY TYPE OF HTN Hypertension management has been found to be beneficial in preventing stroke and cardiac events in all ages. Treatment should begin without regard to age. Elderly
will necessarily slow down his physical activity. Choices a and d have no direct effect on heart rate. Amlodipine is a calcium channel blocker that does not decrease heart rate. A patient taking an angiotensin receptor blocker inhibitor should avoid: strenuous exercise. potassium supplements. protein rich meals grapefruit juice. -------- Correct Answer ---------K+ SUPPLEMENTS An ARB potentially can produce hyperkalemia because its mechanism of action is in the renin-angiotensin-aldosterone system where potassium is spared. If potassium is taken in the form of potassium supplements, the effect will be additive and the risk of hyperkalemia can be great 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? He has reached an age where treatment holds little benefit. Treatment is not age dependent; he should receive niacin today. Treatment is based on expected length of life. He should receive a statin today until he is 85 years -------- Correct Answer ---------older adults have higher rates of coronary events than younger adults do. Treatment of elevated lipids in older adults has been shown to decrease overall mortality, decrease major coronary events, and is associated with relative risk reduction for subsequent coronary events. United States Preventive Services Task Force and American Heart Association recommend lipid-lowering therapy because it clearly benefits older adults. This patient should have a statin started if lifestyle modifications do not allow him to reach goal lipid values. Niacin is poorly tolerated and wouldn't be a first choice in older adults because of hypotension and flushing. HCTZ AND MUSCLE ACHES -------- Correct Answer -------- HYPOK+ HCTZ IS K+ WASTING BEST TEST FOR MVP -------- Correct Answer -------- ECHO The best means to identify mitral valve prolapse (MVP) is with 2D echocardiography. It will identify bulging of either, or both, of the leaflets (anterior or posterior) into the left atrium. Approximately 1 - 2% of the US population is identified to have MVP. A chest x- ray will not enable visualization of the mitral leaflets. Electrocardiography identifies the heart's rhythm. A physical exam may provide great clues to MVP, but in the absence of definitive mid to late systolic clicks, a diagnosis cannot be confirmed
A 40 year-old African American patient has blood pressure readings of 175/100 and 170/102. What is a reasonable plan of care for this patient today? Start low dose thiazide diuretic. Start an ACE inhibitor twice daily. Initiate low dose HCTZ and candesartan. Initiate amlodipine, beta blocker, or ACE inhibitor. Explanation: This patient's blood pressure goal is < 140/90 according to JNC VIII. Since he is more than 20 points above systolic goal (or greater than 10 points above diastolic goal) it is reasonable to consider two medications today. Choice c offers this option. -------- Correct Answer -------- Initiate low dose HCTZ and candesartan. START TWO MEDS IF OVER 20 POINTS This patient's blood pressure goal is < 140/90 according to JNC VIII. Since he is more than 20 points above systolic goal (or greater than 10 points above diastolic goal) it is reasonable to consider two medications today. Choice c offers this option. An immune response to Group A Streptococcal infections involving the heart is: Kawasaki syndrome. rheumatic fever. hemolytic disease. pericarditis -------- Correct Answer -------- RHEUMATIC FEVER Rheumatic fever is the correct answer. The immune response involves not just the heart, but can affect the joints, skin, and central nervous system. 0.1- 0.3% of untreated or under treated infections involving Group A beta hemolytic Strept can result in rheumatic fever. More often than not, this involves an infection in the upper airways. The most common age group affected is 5 - 15 years. However, the residual effect of rheumatic fever is realized into the later decades of life. An elderly patient with hypertension and angina takes multiple medications. Which one of the following decreases the likelihood of his having angina? ACE inhibitor Beta-blocker Diuretic Angiotensin receptor blocker -------- Correct Answer --------- BETA BLOCKER
