A 35 year old female arrives at your clinic. She has had diabetes and peripheral artery disease for the past 5
years. You decide to obtain an ETT. The insurance company argues that this is inappropriate. You justify the
ETT because you are planning secondary strategies to prevent future heart disease. Where could one find the
supporting data for these guidelines?
Medicare guidelines
xFramingham risk score (These guidelines come from the Framingham risk score.)
Medicaid guidelines
Do not exist
Question 2.
You are counseling a patient diagnosed with stress-induced ischemia. You base your discussion on your
knowledge that stress-induced ischemia is thought to be caused by what phenomena?
Diet and exercise
Heart muscle dysfunction
Too many carbonated drinks
xEndothelial dysfunction of the microvascular (You base your discussion on your knowledge that stress-
induced ischemia is thought to be caused by endothelial dysfunction of the microvascular.)
Question 3.
What happens to coronary flow related to CAD?
Hyper profusion of the myocardium
Cerebral vascular infarction
xHypo profusion of the myocardium (Because of the restrictive flow of blook through the coronary arteries,
hypo profusion of the myocardium results from coronary flow related to CAD which causes the presenting
symptoms)
Functional systolic pressures
,Question 4:
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
Women present with the same pattern of CAD as do males
xCAD in women is under diagnosed (You make this choice because you are aware that CAD in women is
under diagnosed.)
To please the patient
Question 5:
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?
Impossible
Negative
xPositive (From your time in the clinic, you know because of wall thinning and hyperkinesis that this test will
be considered to be positive.)
Non-readable
Question 6:
On the echocardiography during the ETT you notice the following change: abnormal left ventricular ejection
fraction. What do these changes suggest related to this patient?
Non-ischemic changes of the baseline ECG
xIschemia of the myocardium (Abnormal left ventricular ejection fraction suggests ischemia of the
myocardium.)
Rise in heart rate without evidence of ischemia
, Weak ventricular muscles
Question 7:
Population disease management is a term used to describe:
High specificity disease states
Low specificity diseases states
Low prevalence specific diseases
xHigh prevalence specific diseases (Population disease management is a term used to describe the high
prevalence of specific diseases.)
Question 8:
Why would inability to exercise reduce the specificity of the routine ETT?
Causes ST-segment changes and P-wave abnormalities
Will not produce any changes in ECG
xProduces persistent ST-segmental changes and T-wave abnormalities (The inability to exercise reduces
the specificity of the routine ETT because it produces persistent ST-segmental changes and T-wave
abnormalities.)
Produces QRS changes that cannot be interpreted
Question 9:
All patients, even if 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
additional justification. From the list below, what could be used to justify an ETT in an asymptomatic patient?
xSedentary and wishes to begin aggressive exercise (Many patients have underlying CAD but remain
asymptomatic. Before beginning any new vigorous activities after years of sedentary lifestyle, it is
recommended to obtain anETT to rule out underlying CAD.)
A smoker of 3 weeks
A member of congress
Developmentally challenged
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