WGU D118 OBJECTIVE ASSESSMENT LATEST 2024/2025
WITH QUESTIONS AND VERIFIED CORRECT ANSWERS/
ALREADY GRADED A++
Treatment of HTN - ANSWER B. For emergency treatment of
HTN in office (BP ≥180/≥120 mmHg); also see Hypertension I, D,
3
1. Transfer to ED if the patient is symptomatic with anything other
than mild H/A
2. Consider captopril 6.25 to 25 mg once or clonidine 0.1 to 0.2
mg initially and then 0.1 mg hourly to a maximum of 0.7 mg; use
with caution if the patient is tachycardic or has cardiac
decompensation
3. Start routine medication (e.g., CCB, ACE, or ARB) and recheck
every 2 to 3 days until BP stabilizes
HTN TX – ANSWER There is no uniform agreement as to which
antihypertensive medication should be given for initial therapy
1. Nonblack patient: thiazide diuretic (especially chlorthalidone),
ACE 'OR' ARB, or long-acting CCB (most often a dihydropyridine)
2. African American patient without kidney disease: CCB, thiazide
diuretic (especially chlorthalidone)
3. Any patient with kidney disease or diabetes: ACE or ARB; an
exception—patient >75 yr of age with impaired renal function
should receive CCB or thiazide diuretic instead
4. Except for additional indications (e.g., rate control with atrial
fib), the amount of BP reduction is more important than the choice
of medication; see Table 8.15 for Antihypertensive Medications
and Dosages and Table 8.16 for Cautions and Contraindications
H. If the BP goal is not reached within a month of starting
treatment, stress adherence to medication and lifestyle changes
and:
1. Increase drug dose or
2. Substitute another drug ("sequential monotherapy") or
,3. Add a second agent
a) Thiazide, if not already on one, is a good choice
b) If the patient is on a beta blocker (BB), use thiazide or
dihydropyridine CCB; ACEs or ARBs may be less effective
because beta blocker decreases renin secretion and thus
angiotensin II formation
c) Use caution in using a BB in combination with
nondihydropyridine CCB (e.g., verapamil or diltiazem) because of
an increased risk of bradycardia or AV block
4. Better response is shown with less side effects if medication is
changed or if additional medication is added after one-step dose
increase (instead of the maximum dose before adding another
medication)
I. If the BP goal is still not met after 1 to 2 mo, consider triple
therapy with an ACE or ARB, CCB, and thiazide diuretic before
using any other class o
A patient who is being treated with a thiazide diuretic for chronic
hypertension reports blurred vision, nausea, and shortness of
breath. The primary care provider notes a blood pressure of
185/115.
What is the recommended initial action for this patient?
Prescribe a calcium channel blocker
Increase the dose of the thiazide medication
Admit to the hospital for evaluation and treatment
Add a beta blocker to the patient's regimen - ANSWER Correct!
Patients with a blood pressure >180/120 or those with signs of
target organ symptoms should be admitted to inpatient treatment
with specialist consultation.
endocarditis - ANSWER Up to 90% of IE patients present with
fever, often associated with chills, poor appetite, and weight loss.
1. Positive blood cultures: one of the following:
a. Typical organisms consistent with infective endocarditis from
two separate cultures (Viridans streptococci, Streptococcus bovis,
,HACEK group, Staphylococcus aureus, or community-acquired
enterococci in the absence of a primary focus)
b. Microorganisms consistent with infective endocarditis from
persistently positive blood cultures (two positive cultures >12 h
apart; or all of three or a majority of four or more separate cultures
with the first and last sample at least 1 h apart)
c. Single positive blood culture for Coxiella burnetii or anti-phase I
immunoglobulin G antibody titer >1 : 800
2. Evidence of endocardial involvement: echocardiogram
demonstrating vegetation, abscess, new prosthetic valve
dehiscence, or new valvular regurgitation
Which medications will be ordered as empiric treatment while
blood cultures are pending for a patient who has native valve
endocarditis?
Penicillin and an aminoglycoside antibiotic
Imipenem-cilastatin and ampicillin
A beta-lactamase resistant penicillin and an antifungal drug
Vancomycin and quinupristin-dalfopristin
. - ANSWER Correct! The most common organism in native valve
endocarditis (NVE) is S. aureus; until resistance is known,
treatment with penicillin and an aminoglycoside is needed,
although most strains causing NVE are not penicillin-resistant
Myocarditis, - ANSWER also known as inflammatory
cardiomyopathy, includes any pathologic process in which
inflammation involving the myocardium is identified.
Initial presentation can be varied and ranges from mild symptoms
of fever, atypical chest pain, fatigue, and palpitations with possible
transient electrocardiographic (ECG) changes to potentially fatal
cardiogenic shock and/or arrhythmias and sudden death.
FEVER, CHILLS, erythrocyte sedimentation rate (ESR) and C-
reactive protein (CRP), will frequently be elevated,IgM to IgG
, n most cases, the clinical expression of myocarditis can be
exemplified by 3 main patterns of presentation
(1) recent-onset heart failure (<6 months), (2) arrhythmias, and
(3) chest pain`
Which laboratory test has the highest predictive value in
diagnosing heart failure due to myocarditis?
Creatine kinase
B-type natriuretic peptide
Viral serological panel
Erythrocyte sedimentation rate - ANSWER Correct! B-type
natriuretic peptide is highly sensitive and specific in diagnosing
heart failure due to myocarditis.
PAD - ANSWER 3 When present, claudication is a tightening or
cramping pain that is precipitated by exercise and relieved by
rest.
. Pain is always relieved immediately by stopping the activity and
never occurs when the patient is at rest.
Absent femoral pulses suggest inflow disease, whereas the
absence of popliteal pulses implies isolated tibial disease.An ABI
of 0.9 or less is indicative of PAD. An ABI of 0.75 to 0.5 is
consistent with claudication, and an ABI below 0.5 is consistent
with rest pain and/or tissue loss. An ABI higher than 1.4 is also
considered abnormal and can indicate the potential for
noncompressible calcified vessels
Aspirin alone (81 to 325 mg/day) or clopidogrel alone (75 mg/day)
is recommended to reduce the risk of MI, stroke, and vascular
death in patients with symptomatic PAD (Level I)
Treatment with a statin is indicated for all patients with PAD
Cilostazol (Pletal), a phosphodiesterase type 3 inhibitor, has been
shown to be an effective therapy to improve symptoms and
increase walking distance in patients with claudication (Level
IA).12 The main contraindication for using cilostazol is a history of
congestive heart failure.
WITH QUESTIONS AND VERIFIED CORRECT ANSWERS/
ALREADY GRADED A++
Treatment of HTN - ANSWER B. For emergency treatment of
HTN in office (BP ≥180/≥120 mmHg); also see Hypertension I, D,
3
1. Transfer to ED if the patient is symptomatic with anything other
than mild H/A
2. Consider captopril 6.25 to 25 mg once or clonidine 0.1 to 0.2
mg initially and then 0.1 mg hourly to a maximum of 0.7 mg; use
with caution if the patient is tachycardic or has cardiac
decompensation
3. Start routine medication (e.g., CCB, ACE, or ARB) and recheck
every 2 to 3 days until BP stabilizes
HTN TX – ANSWER There is no uniform agreement as to which
antihypertensive medication should be given for initial therapy
1. Nonblack patient: thiazide diuretic (especially chlorthalidone),
ACE 'OR' ARB, or long-acting CCB (most often a dihydropyridine)
2. African American patient without kidney disease: CCB, thiazide
diuretic (especially chlorthalidone)
3. Any patient with kidney disease or diabetes: ACE or ARB; an
exception—patient >75 yr of age with impaired renal function
should receive CCB or thiazide diuretic instead
4. Except for additional indications (e.g., rate control with atrial
fib), the amount of BP reduction is more important than the choice
of medication; see Table 8.15 for Antihypertensive Medications
and Dosages and Table 8.16 for Cautions and Contraindications
H. If the BP goal is not reached within a month of starting
treatment, stress adherence to medication and lifestyle changes
and:
1. Increase drug dose or
2. Substitute another drug ("sequential monotherapy") or
,3. Add a second agent
a) Thiazide, if not already on one, is a good choice
b) If the patient is on a beta blocker (BB), use thiazide or
dihydropyridine CCB; ACEs or ARBs may be less effective
because beta blocker decreases renin secretion and thus
angiotensin II formation
c) Use caution in using a BB in combination with
nondihydropyridine CCB (e.g., verapamil or diltiazem) because of
an increased risk of bradycardia or AV block
4. Better response is shown with less side effects if medication is
changed or if additional medication is added after one-step dose
increase (instead of the maximum dose before adding another
medication)
I. If the BP goal is still not met after 1 to 2 mo, consider triple
therapy with an ACE or ARB, CCB, and thiazide diuretic before
using any other class o
A patient who is being treated with a thiazide diuretic for chronic
hypertension reports blurred vision, nausea, and shortness of
breath. The primary care provider notes a blood pressure of
185/115.
What is the recommended initial action for this patient?
Prescribe a calcium channel blocker
Increase the dose of the thiazide medication
Admit to the hospital for evaluation and treatment
Add a beta blocker to the patient's regimen - ANSWER Correct!
Patients with a blood pressure >180/120 or those with signs of
target organ symptoms should be admitted to inpatient treatment
with specialist consultation.
endocarditis - ANSWER Up to 90% of IE patients present with
fever, often associated with chills, poor appetite, and weight loss.
1. Positive blood cultures: one of the following:
a. Typical organisms consistent with infective endocarditis from
two separate cultures (Viridans streptococci, Streptococcus bovis,
,HACEK group, Staphylococcus aureus, or community-acquired
enterococci in the absence of a primary focus)
b. Microorganisms consistent with infective endocarditis from
persistently positive blood cultures (two positive cultures >12 h
apart; or all of three or a majority of four or more separate cultures
with the first and last sample at least 1 h apart)
c. Single positive blood culture for Coxiella burnetii or anti-phase I
immunoglobulin G antibody titer >1 : 800
2. Evidence of endocardial involvement: echocardiogram
demonstrating vegetation, abscess, new prosthetic valve
dehiscence, or new valvular regurgitation
Which medications will be ordered as empiric treatment while
blood cultures are pending for a patient who has native valve
endocarditis?
Penicillin and an aminoglycoside antibiotic
Imipenem-cilastatin and ampicillin
A beta-lactamase resistant penicillin and an antifungal drug
Vancomycin and quinupristin-dalfopristin
. - ANSWER Correct! The most common organism in native valve
endocarditis (NVE) is S. aureus; until resistance is known,
treatment with penicillin and an aminoglycoside is needed,
although most strains causing NVE are not penicillin-resistant
Myocarditis, - ANSWER also known as inflammatory
cardiomyopathy, includes any pathologic process in which
inflammation involving the myocardium is identified.
Initial presentation can be varied and ranges from mild symptoms
of fever, atypical chest pain, fatigue, and palpitations with possible
transient electrocardiographic (ECG) changes to potentially fatal
cardiogenic shock and/or arrhythmias and sudden death.
FEVER, CHILLS, erythrocyte sedimentation rate (ESR) and C-
reactive protein (CRP), will frequently be elevated,IgM to IgG
, n most cases, the clinical expression of myocarditis can be
exemplified by 3 main patterns of presentation
(1) recent-onset heart failure (<6 months), (2) arrhythmias, and
(3) chest pain`
Which laboratory test has the highest predictive value in
diagnosing heart failure due to myocarditis?
Creatine kinase
B-type natriuretic peptide
Viral serological panel
Erythrocyte sedimentation rate - ANSWER Correct! B-type
natriuretic peptide is highly sensitive and specific in diagnosing
heart failure due to myocarditis.
PAD - ANSWER 3 When present, claudication is a tightening or
cramping pain that is precipitated by exercise and relieved by
rest.
. Pain is always relieved immediately by stopping the activity and
never occurs when the patient is at rest.
Absent femoral pulses suggest inflow disease, whereas the
absence of popliteal pulses implies isolated tibial disease.An ABI
of 0.9 or less is indicative of PAD. An ABI of 0.75 to 0.5 is
consistent with claudication, and an ABI below 0.5 is consistent
with rest pain and/or tissue loss. An ABI higher than 1.4 is also
considered abnormal and can indicate the potential for
noncompressible calcified vessels
Aspirin alone (81 to 325 mg/day) or clopidogrel alone (75 mg/day)
is recommended to reduce the risk of MI, stroke, and vascular
death in patients with symptomatic PAD (Level I)
Treatment with a statin is indicated for all patients with PAD
Cilostazol (Pletal), a phosphodiesterase type 3 inhibitor, has been
shown to be an effective therapy to improve symptoms and
increase walking distance in patients with claudication (Level
IA).12 The main contraindication for using cilostazol is a history of
congestive heart failure.
