NSG6001 week 5 final exam graded 2018

1. Question
: More than half of all cardiac
arrhythmias involve the atria.

:
False

True

Points Received: 5 of 5

Comments:

Question 2. Question
: What are the most common
symptoms caused by tachyarrhythmias?

:
Sweating

Thirst

Palpitations

Headaches

Points Received: 5 of 5

Comments:

Question 3. Question
: For women with known CAD and
diabetes, which is most appropriate to assess CAD risk?

:
ETT

Coronary bypass surgery

Coronary catheterization

ETT with imaging

Points Received: 5 of 5

Comments:

Question 4. Question
: Of the following, which is the
best answer when asked for an advantage of echocardiogram exercise testing over
thallium stress testing?

:
Does not depend on operator experience

Costs are the same

Results are available more quickly

Doesn’t matter because there are no advantages

Points Received: 5 of 5

Comments:

Question 5. Question
: Your patient has uncomplicated
pyelonephritis. In deciding your recommended treatment, you consider the most
common pathogenic reason for this diagnosis. What pathogen accounts for the
majority of pyelonephritis?

:
E. Coli

Gardnerella Vaginalis

Mycoplasma Hominis

Chlamydia

Points Received: 5 of 5

Comments:

Question 6. Question
: What purpose does the
principle of fidelity serve in the provider/patient relationship?

:
Ensures that providers honor their commitments
to the patient

Obligates the provider to a one-on-one
relationship with the individual

Ensures that patients receive whatever they
want

Maintains costs in the healthcare arena

Points Received: 5 of 5

Comments:

Question 7. Question
: In CAD, after both systolic
and diastolic dysfunction have occurred, the typical pattern of chest pain and
related EKG changes occur. During an EKG, you should expect to see ST-segment
and T-wave changes that are central to demonstration of ischemia occurring
relatively late in the ischemic cascade. Is this true or false?

:
True

False

Points Received: 5 of 5

Comments:

Question 8. Question
: The leads on the ECG showing
ischemic changes during or immediately after an ETT can correlate roughly to
the culprit artery or arteries with significant CAD. Is this true or false?

:
False

True

Points Received: 5 of 5

Comments:

Question 9. Question
: Skin cancer is the most common
malignant neoplasm in males in the US. What is the second leading cause of
cancer deaths in men greater than 50 years of age?

:
Prostate cancer

Lung cancer

Lymphoma

Lupus

Points Received: 0 of 5

Comments:

Question 10. Question
: What ECG changes can reduce
the specificity of the ETT?

:
Exercise induced bundle branch blocks

Paced rhythm and resting bundle branch block

Paced rhythm and exercise induced bundle
branch blocks

Low voltage up sloping of the ST-segment

Points Received: 5 of 5

Comments:

Question 11. Question
: You have confirmed that your
patient does indeed have an abdominal aortic aneurysm. In teaching your patient
about symptoms to report immediately to the vascular surgeon, you instruct the
patient to report which of the following?

:
Newly diagnosed diabetes

Back pain or flank pain

Visual disturbances

Headaches

Points Received: 5 of 5

Comments:

Question 12. Question
: What is one of the common
causes of a Saccular Abdominal Aneurysm?

:
Poor kidney functioning

Age

Drugs: illicit and prescribed

Trauma

Points Received: 5 of 5

Comments:

Question 13. Question
: The diagnostic accuracy of
stress testing is decreased among women compared to men for what reasons?

:
Women having thinner ventricular and septal muscles

Women usually have single vessel or
non-obstructive disease

Women cannot exercise as vigorously as men

Women typically have multiple vessel disease

Points Received: 5 of 5

Comments:

Question 14. Question
: Population disease management
is a term used to describe:

:
High specificity disease states

Low specificity diseases states

Low prevalence specific diseases

High prevalence specific diseases

Points Received: 5 of 5

Comments:

Question 15. Question
: You receive a report back on
the suspected abdominal aortic aneurysm for your patient. It confirms your
suspicion of AAA. The report describes the aneurysm as a symmetric weakness of
the entire circumference of the aorta. You know that this form of aneurysm is
referred to as what kind of aneurysm?

:
Thoracic aneurysm

Budging sac aneurysm

Saccular aneurysm

Fusiform aneurysm

Points Received: 5 of 5

Comments:

Question 16. Question
: Your practice partner just
ordered an exercise echocardiography 2DE for a patient with suspected
cardiovascular risk. This patient has known resting wall motion abnormalities.
Why would this not be the best test to assess this patient’s cardiac risk?

:
Sensitivity is increased

Sensitivity is decreased

Specificity is increased

Specificity is decreased

Points Received: 0 of 5

Comments:

Question 17. Question
: Your 60-year old male patient
arrives for his appointment. He complains of general malaise and fever over the
past several days with low back pain. He also states that he is getting up at
night more often to urinate and never feels his bladder is completely empty.
What differential diagnosis should you consider in this patient?

:
Acute viral prostatitis

Stomach virus

Acute bacterial prostatitis

BPH only

Points Received: 5 of 5

Comments:

Question 18. Question
: We all know that collaboration
is integral to becoming a successful nurse practitioner. Among collaborations,
however, only one can be considered as the most important. While each example
below is important, which is the most important collaboration? The one that
occurs:

:
Between the nurse practitioner and their physician mentor

Between two healthcare providers about a
single patient

Between the patient and their family

Between the patient and the nurse practitioner

Points Received: 5 of 5

Comments:

Question 19. Question
: The sensitivity of a routine
ETT is effort dependent. What physiological changes occur during effort in the
routine ETT?

:
Rapid heart rates and coronary artery narrowing

Decrease in coronary blood flow

Decreased heart rate and increased systolic
blood pressure

Increased coronary flow and increased systolic
blood pressure

Points Received: 5 of 5

Comments:

Question 20. Question
: A 47-year old female with
general complaints of fatigue and shortness of breath shows up in your clinic
as a referral from another nurse practitioner. Several blood tests and chest
x-rays have been completed without any diagnosis or outstanding abnormalities.
You decide to order an ETT despite the fact that the recent ECG does not show
any abnormalities. From the answers below, which would be the best answer to
support your decision?

:
You are out of other options

CAD in women is under diagnosed

To please the patient

Women present with the same pattern of CAD as do males

Points Received: 5 of 5

Comments:

Question 21. Question
: Your patient underwent an
exercise stress test for CAD. There is significant elevation of the ST-segment.
What do you need to know about these changes to manage your patient’s care?

:
This patient needs to see someone more experienced in treatment of CAD

These changes are predictive of myocardial
infarction

These changes have minimal predictive value
for CAD

These changes predict dire outcomes

Points Received: 5 of 5

Comments:

Question 22. Question
: When there is a consequential
loss of structural integrity of the abdominal aorta, the resulting issue is
what condition?

:
Bloated stomach

Kidney failure

Bleeding ulcers

Abdominal aortic aneurysm

Points Received: 5 of 5

Comments:

Question 23. Question
: You see a 60-year old African
American male in your clinic with a recent diagnosis of hypertension. He asks
you what he should restrict in his diet, and is particularly interested in
limiting his sodium intake. What amount of sodium intake would you recommend on
a daily basis for this patient?

:
1.5 g/day

No added table salt

3.0 g/day

2.3 g/day

Points Received: 5 of 5

Comments:

Question 24. Question
: Why would inability to
exercise reduce the specificity of the routine ETT?

:
Produces QRS changes that cannot be interpreted

Produces persistent ST-segmental changes and
T-wave abnormalities

Causes ST-segment changes and P-wave
abnormalities

Will not produce any changes in ECG

Points Received: 5 of 5

Comments:

Question 25. Question
: By standard criteria, how is a
positive stress test defined?

:
Development of a horizontal or down sloping
ST-segment depression of 1mm

Down sloping of the ST-segment at the J point
of the QRS

Development of a horizontal or down sloping
ST-segment depression of 10mm

Upward sloping ST-segment measured at the J
point of the QRS

Points Received: 5 of 5

Comments:

Question 26. Question
: What are the two types of
bradycardia recognized by the American Heart Association?

:
Relative and absolute

Absolute and pending

Refractory and non-refractory

Relative and dynamic

Points Received: 0 of 5

Comments:

Question 27. Question
: You see a 75-year old female
in your clinic today complaining of urinary incontinence. She is otherwise
healthy based upon her last visit. She states that her mother told her this
would happen someday because it happens to every woman at some age. What would
you tell this patient?

:
This happens to all women as they age

No need to worry. This is normal. Your mother
was correct.

This is not an expected condition related to
aging.

This happens to men as well and most women
before your age.

Points Received: 5 of 5

Comments:

Question 28. Question
: What do you know regarding
ischemia that is confined to only the posterior and or lateral segments of the
left ventricle?

:
ETT cannot be used for detection

Difficult to detect by ETT

Requires both for detection of changes by ETT

Easier to detect by ETT

Points Received: 5 of 5

Comments:

Question 29. Question
: What three conditions
definitely alter the results of echocardiography in determining CAD?

:
Obesity, rapid heart rate and lung disease

Diabetes, kidney disease and tooth decay

Obesity, slow heart rates and hypertension

Previous MI, hypotension and diabetes

Points Received: 5 of 5

Comments:

Question 30. Question
: Specifically, when is an ETT
considered to be negative?

:
Patient has ST-segmental changes with down sloping of greater than 1 mm at 50%
of age-predicted maximum heart rate

Patient exercises to 85% of age predicted
maximum heart rate without evidence of induced ischemia

Patient exercises to 20% maximum age-predicted
heart rate without induced ischemia

Patient exercises until tired without evidence
of induced ischemia

Points Received: 5 of 5

Comments:

Question 31. Question
: All patients, even is
asymptomatic, require risk stratification according to the Farmingham risk
score. At present, ACC/AHA guidelines, however, do not normally support stress
tests for asymptomatic patients without addiitonal justification. From the list
below, what could be used to justify a ETT in an asymptomatic patient?

:
A smoker of 3 weeks

A member of congress

Sedentary and wishes to begin aggressive
exercise

Developmentally challenged

Points Received: 5 of 5

Comments:

Question 32. Question
: BPH is not a risk factor for
Prostate cancer. Is this statement true or false?

:
True

False

Points Received: 0 of 5

Comments:

Question 33. Question
: Spread of genital herpes only
occurs during the time period with active lesions. Is this statement true or
false?

:
False

True

Points Received: 5 of 5

Comments:

Question 34. Question
: Abdominal aortic aneurysms are
often asymptomatic. What percent of AAA’s are discovered in asymptomatic
patients?

:
40%

20%

10%

75%

Points Received: 5 of 5

Comments:

Question 35. Question
: Improvements in the delivery
and management of healthcare are necessary if we are to improve the overall
health of this nation’s population. Which of the following are identified in
your readings as strategic in the movement to improve the healthcare system?

:
President and Congress

Population management and healthcare practice

Socialized medicine and governmental controls

Monetary savings and limited disruption in
healthcare delivery

Points Received: 5 of 5

Comments:

Question 36. Question
: What are the two main types of
heart failure?

:
Systolic and diastolic

Hopeless and severe

Left sided and main

End diastolic and pressure related

Points Received: 0 of 5

Comments:

Question 37. Question
: The majority of all strokes
are non-ischemic. Is this statement true or false?

:
False

True

Points Received: 5 of 5

Comments:

Question 38. Question
: When a murmur is first heard,
it is important to determine if it is due to a pathological condition or
benign. For an experienced practitioner, it is always easy to determine the
cause of a murmur merely by listening to the sound. Is this statement true or
false?

:
True

False

Points Received: 5 of 5

Comments:

Question 39. Question
: Maintenance of an Isometric
ST-segment during exercise is the response of?

:
A normal heart

Hypo profusion

An abnormal heart

CAD

Points Received: 5 of 5

Comments:

Question 40. Question
: The goal of self-management is
to specifically do what?

:
Engage patients in their own care

Engage insurance providers in patient care

Engage providers in patient care

Engage government in greater involvement in
patient care

Points Received: 5 of 5

Comments:

Question 41. Question
: Your 56-year old patient
presents with bradycardia with a rate of 55 and first degree AV block. The
patient is hemodynamically stable and is not experiencing any syncope or chest
pain. History includes previous myocardial infarction. Home medications include
beta blockers, daily aspirin. Lab work is non-significant for electrolyte
imbalance. You decided to treat this patient for the arrhythmia to prevent
future destabilization. From the choices below, which might be the appropriate
first measure to consider?

:
Add digitalis to control the heart rate

Consult cardiologist immediately for guidance

Discontinue Beta Blocker and replace with
another therapy if necessary

Atropine injections

Points Received: 5 of 5

Comments:

Question 42. Question
: Your patient is morbidly obese
and cannot sit on a bicycle or walk a treadmill. She also has marked and severe
emphysema. You need to make an assessment of the risk of significant CAD and
your patient’s family says that their relative had their diagnosis based on an
ultrasound echocardiography. What facts would influence your decision regarding
the family request for echo assessment?

:
Sensitivity would be increased because of lung disease

Specificity would be increased because of
obesity

Sensitivity would be reduced because of
obesity and lung disease

Specificity would be reduced because of
obesity and lung disease

Points Received: 5 of 5

Comments:

Question 43. Question
: You are in the clinic with
your mentor observing the Echocardiogram exercise test of a 45-year old male
that has been experiencing slight chest pressure almost daily during exercise.
While observing your patient, your mentor points out that the left ventricle
wall is thinning and there is some hyperkinesias of the ventricular wall. From
your time in the clinic, you know that this test will be considered to be what
type of result?

:
Negative

Impossible

Positive

Non-readable

Points Received: 5 of 5

Comments:

Question 44. Question
: Your patient is newly
diagnosed with persistent Atria Fibrillation. You consider
electrocardioversion. Before undergoing this procedure you should order the
following examination to assess thrombus risk.

:
X-Ray of chest

Tranesophageal echocardiography

Ultrasound of chest

CT Scan

Points Received: 5 of 5

Comments:

Question 45. Question
: Tachyarrhythmias cause a drop
in commonly blood pressure, cardiac output, syncope, shortness of breath, and
chest pain. What phenomenon most often occurs during these arrhythmias to cause
these symptoms?

:
Shortened diastole

Lengthened diastole

Lengthened systole

Shortened systole

Points Received: 0 of 5

Comments:

Question 46. Question
: At what age is atria
fibrillation most common?

:
In childhood

60 years or older

30 years

45 years

Points Received: 5 of 5

Comments:

Question 47. Question
: Automaticity is a property
common to all cardiac cells. Is this statement true or false?

:
True False

Points Received: 5 of 5

Comments:

Question 48. Question
: Your patient has a maximum
age-predicted heart rate of 180. During the exercise he reaches a heart rate of
140 and then states he can no longer exercise. You see evidence of ischemic
changes on the ECG. This would be predictive of what condition?

:
Stroke

Significant CAD

Impending death

Low risk of CAD

Points Received: 0 of 5

Comments:

Question 49. Question
: You tell a patient that he has
a murmur. He says he has been told this before, but wonders what causes the
unique sounds of a murmur. Which of the following would be your best option?

:
Turbulent flow of blood

High pressures caused from HTN

There is no reason, it just happens

Almost always from a sclerotic valve

Points Received: 5 of 5

Comments:

Question 50. Question
: What is the treatment of
choice for uncomplicated community-acquired cystitis?

:
TMP-SMZ

Any antibiotic will treat this diagnosis

Amoxicillin

Penicillin

Points Received: 5 of 5

Comments:

Question 51. Question
: Any patient presenting with
symptomatic bradycardia should be referred to a cardiologist for management. Is
this statement true or false?

:
False

True

Points Received: 5 of 5

Comments:

Question 52. Question
: Encouragement of patients to
take effective actions in their own healthcare refers to the concept of:

:
Self-management support

Interprofessional support

Physician or provider-driven care

Family care givers

Points Received: 5 of 5

Comments:

Question 53. Question
: You are considering adding an
adjunctive form of testing to detect wall motion abnormalities during the ETT.
You select Echocardiography as the added testing. You choose this test because
you know that echocardiography does what when added to a standard ETT?

:
Enhances sensitivity and specificity of CAD
detection

Enhances sensitivity while reducing
specificity of CAD detection

Enhances specificity while not changing
sensitivity of detection for CAD

You like pretty pictures of wall motion

Points Received: 5 of 5

Comments:

Question 54. Question
: Medicaid is mandated to be
provided by each state through federal codes. Each state must offer Medicaid
exactly as the federal government prescribes. True or false?

:
False

True

Points Received: 5 of 5

Comments:

Question 55. Question
: What sexually transmitted
disease is most widespread in the USA today?

:
Chlamydia

Gonorrhea

Syphilis

HIV/AIDS

Points Received: 5 of 5

Comments:

Question 56. Question
: Your preceptor decides to add
Doppler Flow studies to the echocardiogram exercise test for a patient with a
recent history of a holistic murmur best auscultated at the left steral
boarder. The patient has no history of cardiac surgeries. He asks you what
might be the main advantages of adding Doppler Flow for this particular
patient. You know from your readings that there are several reasons to add
Doppler Flow and below are listed more than one correct reason. Your best
response for this specific case, however, would be that Doppler Flow studies
would be of what additive value during the echocardiogram study?

:
Detect and evaluate blood shunting from a septal
defect

No advantage is seen for this patient

Gives better screen shots of wall abnormalities

Provides assessment of prosthetic valve
function

Points Received: 5 of 5

Comments:

Question 57. Question
: Sexual partners of a patient
with a diagnosed STI should always be examined and treated. Is this statement
true or false?

:
False

True)

Points Received: 5 of 5

Comments:

Question 58. Question
: Your patient presents with
tachycardia. The QRS is measured at 0.10 seconds. Which of the following
tachycardias would be an appropriate conclusion based on this information
alone?

:
Ventricular tachycardias

Premature junctional contractions

Atria fibrillation

Ventricular fibrillation

Points Received: 5 of 5

Comments:

Question 59. Question
: A 65-year old white male
arrives in your clinic with general complaints of slight abdominal discomfort.
He has a known history of smoking two packs per day for 40 years and
hypertension. He also has COPD and has been treated numerous times with oral
steroids. You consider several optional diagnoses. Of the ones listed below,
which should be included as a potential top suspect in your choice of
diagnosis?

:
Chronic bowel obstruction

Meglacolon

Appendicitis

Abdominal aortic aneurysm

Points Received: 5 of 5

Comments:

Question 60. Question
: What are the most common
mechanisms to produce cardiac arrhythmias?

:
Decreased automaticity, triggered activity or reentry

Reentry, electrical dysfunction or activity

Stress, hard work or swimming

Enhanced automaticity, triggered activity or
reentry

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