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APEA Exam Cardio – Question with Answers

1. A medication that may produce exercise intolerance in a patient who has hypertension is:
2. 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?
3. An 80-year-old female who is otherwise well has the following blood pressure readings. How should she be managed pharmacologically?
4. 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:
5. Most hypertension in preadolescents and children is:
6. A patient taking an angiotensin receptor blocker (ARB) should avoid:
7. 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?
8. Older adults have a unique blood pressure pattern. Which blood pressure reading below reflects this pattern?
9. Pharmacologic treatment for children who have hypertension should be initiated for:
10. The usual clinical course of mitral valve prolapse:
11. The correlation between blood pressure and age greater than 60 years is that as age increases:
12.  Classic symptoms of deep vein thrombosis (DVT) include:
13. 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?
14. 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?
15. Which class of medication is frequently used to improve long-term outcomes in patients with systolic dysfunction?
16. In older adults, the three most common ailments are:
17. Pharmacologic treatment for older adults with hypertension should be initiated:
18. 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?
19. 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:
20. How often should blood pressure be measured in a child who is 3 years old?
21. 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:
22. Which item below represents the best choice of antihypertensive agents for the indicated patient?
23. You are managing the warfarin dose for an older adult with a prosthetic heart valve. Which situation listed requires that warfarin be discontinued now?
24. Which group of medications would be detrimental if used to treat a patient who has heart failure (HF)?
25. A 75-year-old patient who has aortic stenosis wants to know what symptoms indicate worsening of his stenosis. The nurse practitioner replies:
26. Which choice below characterizes a patient who has aortic regurgitation?
27. Besides hypertension, which risk factor most contributes to development of an abdominal aortic aneurysm?
28. A 28-year-old has a Grade 3 murmur. Which characteristic indicates a need for referral?
29. 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:
30. Which laboratory abnormality may be observed in a patient who takes lisinopril?
31. 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?
32. 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?
33. Which patient could be expected to have the highest systolic blood pressure?
34. A decrease in blood pressure can occur in men who take sildenafil (Viagra) and:
35. A patient who takes HCTZ 25 mg daily has complaints of muscle cramps. He probably has:
36. Drugs that target the renin-angiotensin-aldosterone system are particularly beneficial in patients who have:
37. A 25-year-old patient has aortic stenosis (AS). The etiology of his AS is probably:
38. 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?
39. Which hypertensive patient is most likely to have adverse blood pressure effects from excessive sodium consumption?
40. The most common indicator of end-organ damage in adolescents with hypertension is:
41. How often should lipids be screened in patients who are 65 years and older if they have lipid disorders or cardiovascular risk factors?
42. Which medication listed below could potentially exacerbate heart failure in a susceptible patient?
43. 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:
44. Mr. Daigle is an 80-year-old patient who takes warfarin for chronic atrial fibrillation. The nurse practitioner should:
45. A patient will be screened for hyperlipidemia via a serum specimen. He should be told:
46. 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:
47. Which of the following medications may have an unfavorable effect on a hypertensive patient’s blood pressure?
48. A patient taking candesartan for treatment of hypertension should avoid:
49. A 74-year-old patient has peripheral artery disease (PAD). Which item listed below is an important nonmodifiable risk factor for PAD?
50. 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:
51. The most common arrhythmia resulting from valvular heart disease is:
52. Where would the murmur associated with mitral regurgitation best be auscultated?
53. A congenital heart abnormality often discovered during the newborn period is coarctation of the aorta. How is this assessed?
54. The carotid arteries are auscultated for bruits because:
55. Which test listed below may be used to exclude a secondary cause of hyperlipidemia in a patient who has elevated lipids?
56. Risk assessment for dyslipidemia should begin at:
57. Mrs. Jones is an 85-year-old who has average blood pressures of 170/70 mmHg. Which agent would be a good starting medication to normalize her blood pressure?
58. Benazepril should be discontinued immediately if:
59. An immune response to Group A Streptococcal infections involving the heart is:
60. 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:
61. 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?
62. 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?
63. Mr. Brown a 45-year-old African American male has the following lab values. What should the nurse practitioner do next?
64. Which test below is most cost-effective to screen for abdominal aortic aneurysm?
65. A 50-year-old patient with hypertension has taken hydrochlorothiazide 25 mg daily for the past 4 weeks. How should the nurse practitioner proceed?
66. An older adult who has hypertension and angina takes multiple medications. Which one of the following decreases the likelihood of his having angina?
67. The major difference between varicose veins and arteriosclerosis is the:
68. Which choice below would be the best choice for an 80-year-old patient whose blood pressure is 172/72 mm Hg?
69. Which infant feeding behavior is least likely related to congenital heart disease (CHD)? 70. The diagnosis of mitral valve prolapse can be confirmed by:
70. Which medication could potentially exacerbate heart failure (HF)?
71. An older adult has renal insufficiency, hypertension, osteoarthritis, hypothyroidism, and varicose veins. Which medication should be avoided?
72. 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?
73. At what age should initial blood pressure screening take place?
74. A patient with hypertension has been diagnosed with gout. Which home medication may have contributed to this episode of gout?
75. An ACE inhibitor is specifically indicated in patients who have:
76. 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?
77. The valve most commonly involved in chronic rheumatic heart disease is the:
78. Which study would be most helpful in evaluating the degree of hypertrophy of the atrium or ventricle?
79. 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?
80. 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?
81. Which antibiotic should be used with caution if an older patient has cardiac conduction issues?
82. A common side effect of thiazide diuretics is:
83. A child’s resting heart rate is expected to be between 60 and 100 beats per minute once he reaches:
84. 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?
85. A 75-year-old patient with longstanding hypertension takes an ACE inhibitor and a thiazide diuretic daily. He has developed dyspnea on exertion and peripheral edema over the past several days. This probably indicates:
86. 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 have an absence of hair growth on his lower legs. Which statement is true regarding this patient?
87. Which patient is most likely to have mitral valve prolapse?
88. 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:
89. Which mitral disorder results from redundancy of the mitral valve’s leaflets?
90. Orthostatic hypotension can be diagnosed in an older adult if the systolic blood pressure decreases:
91. Ramipril has been initiated at a low dose in a patient with heart failure. What is most important to monitor in about 1 week?
92. A 64-year-old male has been your patient for several years. He is a former smoker. He presents to your clinic with complaints of fatigue and “just not feeling well” for the last few days. His exam is normal.
93. His blood pressure is well controlled. His medication list, most recent lipid panel, and today’s vital signs are provided. What should be done next?
94. A patient has had poorly controlled hypertension for more than 10 years. Indicate the most likely position of his point of maximal impulse (PMI):
95. An older adult who has hypertension also has osteoporosis. Which antihypertensive agent would have the secondary effect of improving her osteoporosis?
96. 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?
97. 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:
98. 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?
99. A patient taking an ACE inhibitor should avoid:
100. You have been asked to evaluate a heart murmur in a pregnant patient. Can a 3D echocardiogram be safely used to evaluate her?
101.  In order to reduce lipid levels, statins are most beneficial when taken:
102. A patient is diagnosed with mild heart failure (HF). What drug listed below would be a good choice for reducing morbidity and mortality long term?
103. A common, early finding in patients who have chronic aortic regurgitation (AR) is:
104. Three of the following medications warrant monitoring of potassium levels. Which one does NOT?
105. A young child has an audible murmur. The nurse practitioner describes it as a grade 4 murmur. How should this be managed?
106.  Mrs. Brandy is having contrast dye next week for a heart catheterization. What drug does NOT need to be stopped prior to her catheterization?
107. Tables are used for determination of maximum blood pressure values for adolescents. How are these blood pressure values established for adolescents?
108. A characteristic of an ACE inhibitor-induced cough is that it:
109. A patient has shortness of breath. If heart failure is the etiology, which test demonstrates the highest sensitivity in diagnosing this?
110. The lipid particle with the greatest atherogenic effect is: