(Test Bank) Walden University_APEA Questions and Answers

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APEA Questions Cardiovascular Disorders Benazepril should be discontinued immediately if: pregnancy occurs. 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? 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 dyspnea on exertion and peripheral edema over the past several days. This development of heart failure (HF). 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 Ciprofloxacin cardiac conduction issues? 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 Furosemide home medication may have contributed to this episode of gout? 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 h eart 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 ha ve an absence of hair growth on his lower legs. Which statement is true regarding this patient? This might indicate disease in the lower extremities. 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 heart failure (HF). developed atrial fibrillation. The nurse practitioner knows that this patient is at risk for: 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 stop warfarin for the next atrial fibrillation. The nurse practitioner should: 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 diabetics with hypertension. should be initiated for: 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. The diagnosis of mitral valve prolapse can be confirmed by: echocardiography. 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? Amlodipine Which laboratory abnormality may be observed in a patient who takes lisinopril? Increased potassium level Which medication listed below could potentially exacerbate heart failure in a susceptible patient? Metoprolol A congenital heart abnormality often discovered during the newborn period is coarctation of the aorta. How is this assessed? By comparing upper and lower extremity blood pressures 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. His blood pressure is well controlled. His medic ation list, most recent lipid panel, and today's vital signs are provided. What should be done next? Order a CBC, metabolic panel, TSH, and urine analysis. An 80 -year -old female who is otherwise well has the following blood pressure readings. How should she be managed pharmacologically? Calcium channel blocker Which infant feeding behavior is least likely related to congenital heart disease (CHD)? Infants that burp frequently when feeding Dermatological Disorders A 70 -year -old is diagnosed with multiple cherry angiomas. The nurse practitioner knows that: these may bleed profusely if ruptured. A patient is found to have koilonychia. What Complete blood count laboratory test would be prudent to perform? Most cases of atopic dermatitis exacerbation are treated with: topical steroids. Which vehicle is least appropriate in a patient who has atopic dermatitis? Lotions A 23 -year -old male appears in clinic with the following lesion on his trunk. This lesion is usually associated with: pityriasis rosea. The nurse practitioner examines a patient who has had poison ivy for 3 days. She asks if she can spread it to her family members. The nurse practitioner replies: “No, transmission does not occur from the blister’s contents.” A patient will be taking oral terbinafine for fingernail fungus. The NP knows that: terbinafine is an inhibitor of the CYP 2D6 enzymes. Mr. Johnson is a 74 -year -old who presents with a pearly -domed, nodular -looking lesion on the back of the neck. It does not hurt or itch. What is a likely etiology? Basal cell carcinoma A patient reports that he found a tick on himself about 2 weeks ago. He presents today with a red circle and a white center near where he remembers the tick bite. He did not seek treatment at that time. Today he ELISA complains of myalgias and arthralgias. Which laboratory test can be used to help diagnose Lyme disease? A patient with a positive history of a tick bite about 2 weeks ago and erythema migrans has a positive ELISA for Borrelia burgdorferi. The Western blot is positive. How should he be managed? He should receive doxycycline for Lyme disease. A 74 -year -old male patient has sustained a laceration to his foot. His last tetanus shot was more than 10 years ago. He has completed the primary series. What should be recommended? Tetanus, diphtheria, and acellular pertussis (Tdap) A 71 -year -old female presents with a vesicular rash that burns and itches. Shingles is diagnosed. An oral antiviral: should be started within 72 hours of the onset of symptoms. A microscopic examination of the sample taken from a skin lesion indicates hyphae. What type of infection might this indicate? Fungal Topical 5 -fluorouracil (5 -FU) is used to treat: basal cell carcinoma. A patient was burned with hot water. He has several 2-3 cm fluid -filled lesions. What are these termed? Bullae Which test is NOT suitable to diagnose shingles if the clinical presentation is questionable? Complete blood count (CBC) A patient has been in the sun for the past few weeks and has developed darkened skin and numerous 3 -6 mm light -colored, flat lesions on his trunk. What is the likely etiology? Tinea versicolor Which of the following antibiotics may increase the likelihood of photosensitivity? Ciprofloxacin A low -potency topical hydrocortisone cream would be most appropriate in a patient who has been diagnosed with: atopic dermatitis. A 16 -year -old male has nodulocystic acne. What might have the greatest positive impact in managing his acne? Isotretinoin (Accutane) The agent commonly used to treat patients with scabies is permethrin. How often should it be applied to eradicate scabies? Once A 40 -year -old female patient presents to the clinic with multiple, painful reddened nodules on the anterior surface of both legs. She is concerned. These are probably associated with her history of: ulcerative colitis. A patient presents with plaques on the extensor surface of the elbows, knees, and back. The plaques are erythematous and thick, silvery scales are present. This is likely: plaque psoriasis. Which of the following skin lesions in an older adult is a premalignant condition? Actinic keratosis A patient has seborrheic dermatitis. Which vehicle would be most appropriate to use in the hairline area to treat this? Foam A 16 -year -old has been diagnosed with Lyme disease. Which drug should be used to treat him? Doxycycline A patient exhibits petechiae on both lower legs but has no other complaints. How should the NP proceed? Order a CBC Which chronic skin disorder primarily affects hairy areas of the body? Seborrheic dermatitis A skin lesion that is a solid mass is described as a: papule. An older adult patient has been diagnosed with shingles on the right lateral aspect of her trunk. It initially appeared yesterday. It is very painful. How should she be managed? An oral antiviral agent and pain medication A patient has been diagnosed with scabies. What is the medication of choice to treat this? Permethrin Patients with atopic dermatitis are likely to exhibit: itching. The primary therapeutic intervention for patients who present with hives is: antihistamines. Which of the following lesions never blanches when pressure is applied? Purpura or petechiae The most common form of skin cancer is: basal cell carcinoma. Which of the following areas of the body has the greatest percutaneous absorption? Genitalia A patient presents to the minor care area of the emergency department after being bitten by a dog. The patient states that the dog had a tag around his neck and had been seen roaming around the neighborhood for days before the patient was bitten. The dog did not exhibit any odd be havior. How should this be managed? Report the bite to animal control and administer appropriate medical care. A 28 -year -old has thick, demarcated plaques on her elbows. Which features are suggestive of psoriasis? Silvery scales that are not pruritic A patient is diagnosed with tinea pedis. A microscopic examination of the sample taken from the infected area would likely demonstrate: hyphae. The most common place for basal cell carcinoma to be found is the: face. A 60 -year -old patient is noted to have rounding of the distal phalanx of the fingers. What might have caused this? Hepatic cirrhosis A 68 -year -old female adult with pendulous breasts complains of “burning” under her right breast. The nurse practitioner observes a malodorous discharge with mild maceration under both breasts. What is this? Intertrigo A skin disorder has a hallmark finding of silvery scales. What word below describes this common condition? Chronic A wound has the following characteristics; partial thickness loss of dermis, a shallow open ulcer with red/pink bed, and no evidence of sloughing. What stage of pressure ulcer does this describe? Stage II A patient has been diagnosed with MRSA. She is allergic to sulfa. Which medication could be used to treat her? Doxycycline A patient has a “herald patch” and is diagnosed with pityriasis rosea. Where is the “herald patch” most commonly found? On the chest The American Cancer Society uses an ABCDE mnemonic to help patients develop awareness of suspicious skin lesions. What does the “B” represent? Border A patient calls your office. He states that he just came in from the woods and discovered a tick on his upper arm. He states that he has removed the tick and the area is slightly red. What should he be advised? No treatment is needed. An example of a first -generation cephalosporin used to treat a skin infection is: cephalexin. A skin lesion fluoresces under a Wood’s lamp. What microscopic finding is consistent with this? Hyphae A patient with a primary case of scabies was probably infected: 3-4 weeks ago. A patient has 10 cm of well demarcated erythema on his lower leg that is raised and warm to touch. He had an abrupt onset of lower leg pain, and fever that began 36 hours ago. What is this? Erysipelas An adolescent takes isotretinoin for nodulocystic acne. She is on oral contraceptives. Both were prescribed by the dermatologist. The adolescent presents to your clinic with a sinus infection. Her temperature is 99.5° F and her blood pressure is 160/100 mmHg. How should this be managed? Call the dermatol ogist to report the elevated BP A 74 -year -old woman is diagnosed with shingles. The NP is deciding how to best manage her care. What should be prescribed? An oral antiviral agent Hand -foot -and-mouth disease and herpangina: are viral infections caused by Coxsackie viruses. A 23 -year -old male appears in clinic with the following nonpruritic lesion on his trunk. He first noticed this about 3 days ago. The lesion is probably: a herald patch. A patient has suspected scarlet fever. He likely has a sandpaper rash and: a positive rapid Strept test. A patient who is at high risk for skin cancer should: examine his skin monthly for changes. A 9-year -old female has presented to your clinic because of a rash on the left, upper area of her anterior trunk. She is embarrassed and very reticent to Examine all other areas of the trunk, then ask the child to lift her blouse lift her blouse because her nipple will be exposed. How should the NP proceed? When can a child with chickenpox return to daycare? After all lesions have crusted A topical treatment for basal cell carcinoma is: 5-fluorouracil. A 4-year -old has been diagnosed with measles. The nurse practitioner identifies Koplik’s spots. These are: found on the inside of the cheek and are granular. A child has 8 -10 medium brown café au lait spots > 1 cm in diameter. The differential diagnosis should include: neurofibromatosis. An infant is diagnosed with diaper dermatitis. Satellite lesions are visible. This should be treated with a: topical antifungal agent. A pregnant mother in her first trimester has a 5 -year - old who has Fifth Disease. What implication does this have for the mother? There is a risk of fetal death if she becomes infected. Impetigo is characterized by: honey -colored crusts. An example of a premalignant lesion that develops on sun-damaged skin is: actinic keratosis. The nurse practitioner is examining a 3 -month -old infant who has normal development. She has identified an alopecic area at the occiput. What should be done? Encourage the caregiver to change the infant’s head position A patient with eczema asks for a recommendation for a skin preparation to help with xerosis. What should the NP respond? Use a petroleum -based product The term caput succedaneum refers to: scalp edema. A 9-year -old has been diagnosed with chickenpox. A drug that should be avoided in him is: aspirin. A 6-year -old patient with sore throat has coryza, hoarseness, and diarrhea. What is the likely etiology? Viral etiology A patient presents with small vesicles on the lateral edges of his fingers and intense itching. On close inspection, there are small vesicles on the palmar surface of the hand. What is this called? Dyshidrotic dermatitis The best way to evaluate jaundice associated with liver disease is to observe: the sclera, skin, and lips. The nurse practitioner identifies satellite lesions in a 6 - month -old infant. These are: indicative of candidal infection.