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NR 603 Week 3 Quiz – Question and Answers

1. Per 2013 ACC/AHA guidelines, which patient below would NOT benefit from statin therapy?
2. Which of the following patients should be on high-intensity statin therapy, if tolerated?
3. For someone who is intolerant to higher doses of statins, has tried 2-3 statins…what do we recommend?
4. You have a patient with ASCVD but no comorbidities. Their LDL has gone down 30% from baseline and they are on maximally tolerated statin therapy. 
   Is this patient appropriate for non-statin therapy and if so, what do you recommend?
5. IG is a 47 yo male with CAD s/p MI 2015. He is currently prescribed atorvastatin 20 mg/day. Pt states he is unable to tolerate higher doses and refuses to try another statin. LDL 114 mg/dL. What is the next best step? 
6. YZ is a 67 yo female with DM and 10 year risk score 11.1%. She is currently prescribed atorvastatin 80 mg once daily with reported adherence. Current LDL-C 141 mg/dL. What is the next best step for cardiovascular risk reduction. 
7. TL is a 52 yo black male overbooked in your clinic today for evaluation of fasting labs per primary provider request. He is without complaints. 
   Pertinent medications include amlodipine 10 mg/day and atorvastatin 20 mg/day
   + tobacco use, 3-4 beer/nightLabs: TC 302, HDL 21, TG 1167, direct LDL 152, SCr 1.1
   BP 145/78, height 74 inches, weight 113.4 kg
8. Which of the following drugs inhibits factor IIa (thrombin) and factor Xa by activating antithrombin?
9. Which of the following drugs have pharmacogenomic information in the FDA label? Select all correct answers (there may be more than one).              
10. Variants in which of the following genes have the most compelling evidence for association with clopidogrel response?
11. Brown a 45-year-old African American male has elevated lipids. What should the nurse practitioner do next?                      
12. Which of the following medications may have an unfavorable effect on a hypertensive patient’s blood pressure?
13. Which group of medications would be detrimental if used to treat a patient who has heart failure
14. A patient with hypertension has been diagnosed with gout. Which home medication may have contributed to this episode of gout?
15. Which of the following class of drugs is preferred treatment for a diabetic with stage II hypertension?
16. You are caring for a 30-year-old white male in your office with a BP of 144/90. He has never had a diagnosis of hypertension. He doesn’t check his blood pressure at home. He has a family history of hypertension. What are your recommendations?
17. You are treating a young adult female with HTN and migraine headaches. Which class of medications could you choose to treat both?
18. A 42-year-old male presents with the following lipid profile. He is not on any medications for cholesterol or herbal supplements. What medication would you recommend?
19. You are caring for a 68-year-old male who has been taking atorvastain (Lipitor) for 8 weeks. He complains of fatigue, muscle aches, and dark-colored urine. Which of the following is the most appropriate treatment plan?
20. What would you advise this patient regarding taking his atrovastatin (Lipitor)?
21. A 58 year old male presents to your office with an episode of chest tightness in his substernal area that radiated to his back while he was jogging. It was relieved with rest. Which of the following does this best describe?
22. Which of the following antihypertensive medications would you avoid prescribing for an elderly white female with the comorbid diagnosis of osteoporosis?
23. What is the most common cause of left ventricular hypertrophy in the United States
24. Which of the following heart sounds is associated with heart failure?
25. While performing a routine physical exam on a 60-year-old hypertensive male, you notice a bruit over the carotid area on the left side of the neck. There is no induration of the skin. This patient is at higher risk for
26. A 72-year-old female presents to your office with gradual difficulty breathing, non-productive cough, bilateral swelling of her feet, and a 10 pound weight gain. Upon examination you hear crackles and rhonchi with an S3 heart sound. What is the most likely diagnosis?
27. What is your treatment plan for this patient with difficulty breathing, cough, weight gain, edema, and S3 heart sounds?
28. You are treating a 49-year-old female who presents with fatigue and palpitations. You check her apical pulse and she is irregular and tachycardic. You obtain an EKG and it reveals afib with rapid ventricular response. What is your treatment plan?
29. Upon examination of a 17-year-old during a sports physical, you hear a split S2 during inspiration that disappears during expiration. The patient denies chest pain and dyspnea. What will you tell the mother and patient regarding your findings?
30. Which of the following findings are suggestive of renovascular hypertension?
31. Selma has acute peripheral arterial occlusion of a lower extremity. Before you begin your examination, you know that it:
32. Marvin, age 56, is a smoker with diabetes mellitus. He has just been diagnosed as hypertensive. Which of the following drugs has the potential to cause the development of bronchial asthma and inhibit gluconeogenesis?
33. Nathan, age 63, comes for his annual physical. He has a history of mild hypertension and hyperlipidemia that he has not been successful in treating by diet and weight loss. His only complaint is a problem with impotence. On physical examination, you note a palpable, pulsatile abdominal mass in the umbilical region; a bruit above the umbilical region; and diminished femoral pulses. You suspect:
34. Which of the following usually indicates hyperlipidemia?
35. Ted, age 18, is to have a cardiac screening examination to determine if he can play college basketball. The diagnostic test of choice for detecting hypertrophic cardiomyopathy or idiopathic left ventricular hypertrophy is a(n):
36. Which of the following conditions or medications can increase triglycerides?
37. What is the most important question to ask when a client presents with chest pain?
38. Pathological U waves on the electrocardiogram are most commonly associated with which disorder?
39. Cough, loss of taste, and rash are adverse effects associated with which class of antihypertensive agents?
40. According to the Eighth Joint National Committee JNC 8 guidelines, what is the goal BP level in healthy patients age 60 and older? 
41. Signs of right-sided heart failure include:
42. Rick is modifying his diet to try to lose weight, but after 3 months, he has not lost any weight, even though he has complied with his diet plan. A follow-up lipid profile reveals the following: total cholesterol, 238 mg/dL; triglycerides, 100 mg/dL; high-density lipoprotein cholesterol, 28 mg/dL; and low-density lipoprotein cholesterol, 190 mg/dL. What would you recommend?
43. jeremiah has been on lipid-lowering therapy (statins) for 2 years. He is new to your practice. He says, “I haven’t had my liver function tests (LFTs) in a while to check if my cholesterol medication is causing a problem.” What do you tell him?
44. Which of the following statements is true about hypertension (HTN) during pregnancy?
45. Mr. Michaels has a long-standing cardiac problem. His electrocardiogram rhythm strip is shown below. Which medication should he be taking to prevent a pulmonary or cerebral problem?
    Afibrhythm
46. While much teaching is needed for your client with congestive heart failure, the most beneficial thing you can tell him that might prevent rehospitalization may be:
47. A patient with a shallow ulcer on foot with edema to that leg presents. The patient the effected leg has had a chronic dull pain for the last year. Based on these findings the nurse practitioner suspects what diagnosis?