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NRNP 6531 Latest Update Questions and Correct Answers With Rationales | Rated A+
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NRNP 6531 Latest Update 2023-2024Questions and Correct Answers With
Rationales | Rated A+
A 70-year-old male patient has an aortic aneurysm measuring 5.0 cm. The patient has
poorly- controlled hypertension, and decompensated heart failure. What is the
recommendation for treatment for this patient?
a. Endovascular stent grafting of the aneurysm
b. Immediate open surgical repair of the aneurysm
c. No intervention is necessary for this patient
d. Serial ultrasonographic surveillance of the aneurysm - ANSWERS-ANS: D
This patient's aneurysm is less than 5.5 cm and repair is not necessary at this time.
Serial US surveillance is necessary to continue to evaluate size. Repair is risky in
patients with hypertension and heart failure, so avoiding procedures if possible is
recommended.
A patient reports sustained, irregular heart palpitations. What is the most likely cause of
these
symptoms?
a. Anemia
b. Atrial fibrillation
c. Extrasystole
d. Paroxysmal attacks - ANSWERS-ANS: B
Atrial fibrillation causes palpitations that are irregular and tend to be sustained. Anemia
will cause rapid palpitations that are regular. Extrasystole causes palpitations or an
awareness of isolated extra beats with a pause. Paroxysmal attacks start and terminate
abruptly and are usually rapid and regular.
3. A child with a history of asthma is brought to the clinic with a rapid heart rate. A
cardiac monitor shows a heart rate of 225 beats per minute. The provider notifies
transport to take the child to the emergency department. What initial intervention may
be attempted in the clinic?
a. Administration of intravenous adenosine
b. Giving a beta blocker
c. Providing a loading dose of digoxin
d. Using a vagal maneuver or carotid massage - ANSWERS-ANS: D
This child has paroxysmal supraventricular tachycardi
a. Vagal maneuvers or carotid massage may be attempted to slow the ventricular rate.
Adenosine is contraindicated in patients with asthm
,a. Medications such as beta blockers and digoxin are not used in emergency treatment
of PSVT.
1. According to current research, which are associated with a decreased incidence of
stroke?
a. ≧7 servings of fruits and vegetables per day
b. B-complex vitamin supplements
c. Intensive insulin therapy in type 1 diabetes
d. Low-sugar soda
e. Mediterranean diet - ANSWERS-ANS: A, C, E
Individuals without hypertension in Sweden who consumed ≧7 servings of fruits and
vegetables per day had a 19% lower risk of stroke than those consuming only one
serving per day. Intensive insulin therapy in patients with type 1 diabetes was shown to
lower the risk of stroke. Consuming a Mediterranean diet is associated with a reduced
stroke risk. B-complex vitamins and low-sugar soda have not shown a
decreased risk.
2. During a routine health maintenance examination, the provider auscultates a cervical
bruit. The patient denies syncope, weakness, or headache. What will the provider do,
based on this finding?
a. Order a carotid duplex ultrasound
b. Order catheter-based angiography
c. Refer the patient to a neurosurgeon
d. Schedule a computed tomography angiography - ANSWERS-ANS: A
Carotid duplex ultrasound is the primary diagnostic tool for carotid stenosis. A cervical
bruit in an asymptomatic patient is an indication for this test. Catheter-based
angiography is the criterion-based standard, but has inherent costs and risks. A
neurosurgery referral is not indicated without further testing. CTA is used instead of
duplex US if the test is not available, if US results are inconclusive, or further evaluation
is needed based on US results.
1. A patient reports recurrent chest pain that occurs regardless of activity and is not
relieved by rest. The provider administers a nitroglycerin tablet which does not relieve
the discomfort. What is the next action?
a. Administer a second nitroglycerin tablet
b. Give the patient a beta blocker medication
c. Prescribe a calcium channel blocker mediation
d. Start aspirin therapy and refer the patient to a cardiologist - ANSWERS-ANS: B
Patient with these symptoms who do not respond to nitroglycerin is likely to have
microvascular angin
a. Treatment is effective with beta blockers. These symptoms are not characteristic of
acute MI, so aspirin is not given. A second nitroglycerin tablet is used for classic angin
a. Calcium channel blockers are not indicated.
,2. A patient is brought to an emergency department with symptoms of acute ST-
segment elevation MI (STEMI). The nearest hospital that can perform percutaneous
coronary intervention (PCI) is 3 hours away. What is the initial treatment for this patient?
a. Administer heparin
b. Give the patient an oral beta blocker
c. Initiate fibrinolytic treatment
d. Transfer to the PCI-capable institution - ANSWERS-ANS: C
Fibrinolytic therapy should be administered to any patient with evolving STEMI within 30
minutes of the time of first medical contact. Patients more than 120 minutes away from
a PCI-capable hospital should be given fibrinolytic therapy since PCI should be
performed within 90 minutes if possible. Giving heparin or beta blockers is not helpful.
3. Patients who meet the criteria for statin therapy to help prevent atherosclerotic
cardiovascular disease are those with a history of
a. a 10-year risk score of 5% and an LDL of 165 mg/dL.
b. a 10-year risk score of 8% with an LDL of 80 mg/dL.
c. a low-density lipoprotein (LDL) level >190 mg/dL.
d. diabetes and an LDL between 40 and 70 mg/dL.
e. previous myocardial infarction. - ANSWERS-ANS: B, C, E
Patients with previous MI, those with risk scores >8% and an LDL >70 mg/dL, and those
with LDL levels >190 mg/dL are candidates for statin therapy. Patients with a risk score
<7.5% with LDL levels between 75 and 190 mg/dL are not candidates and patients who
have diabetes with LDL levels <75 mg/dL are not candidates.
1. A patient who has heart failure with reduced ejection fraction will have which
symptoms?
a. Dyspnea and fatigue without volume overload
b. Impairment of ventricular filling and relaxation
c. Mild, exertionally related dyspnea
d. Pump failure from left ventricular systolic dysfunction - ANSWERS-ANS: D
Heart failure with reduced ejection fraction results in pump failure from ventricular
systolic dysfunction. Heart failure with preserved ejection fraction may have milder
symptoms and is associated with impairment of ventricular filling and relaxation.
2. A patient who has been diagnosed with heart failure for over a year reports being
comfortable while at rest and experiences palpitations and dyspnea when walking to the
bathroom. Which classification of heart failure is appropriate based on these
symptoms?
a. Class I
b. Class II
c. Class III
, d. Class IV - ANSWERS-ANS: B
Patients with Class II heart failure (HF) will have slight limitation of activity and will be
comfortable at rest with symptoms occurring with ordinary physical activity. Patients with
Class I HF do not have limitations and ordinary physical activity does not produce
symptoms. With Class III HF, less than usual activity will produce symptoms. With Class
IV HF, symptoms are present even at rest and all physical activity worsens symptoms.
3. A patient who has Class II heart failure is taking an ACE inhibitor and reports a
recurrent cough that does not interfere with sleep or activity. What will the provider do
initially to manage this patient?
a. Assess serum potassium and sodium immediately
b. Discontinue the ACE inhibitor and prescribe an ARB
c. Provide reassurance that this is a benign side effect
d. Withhold the drug and evaluate renal and pulmonary function - ANSWERS-ANS: C
Cough occurs in about 20% of patients who take ACE inhibitors and is not dangerous.
The patient should be reassured that this is the case. If the cough is annoying, alternate
therapy with an ARB may be considered. It is not necessary to evaluate electrolytes,
renal function, or pulmonary function.
1. Which are causes of secondary hypertension?
a. Increased salt intake
b. Isometric exercises
c. Nonsteroidal anti-inflammatory drugs
d. Oral contraceptives
e. Sleep apnea - ANSWERS-ANS: C, D, E
NSAIDs and OCPs can both increase the risk of hypertension. Sleep apnea causes
secondary
hypertension. Increased salt intake does not cause HTN, but those with HTN are more
sensitive to sale. Regular isometric exercise can decrease blood pressure.
2. A 55-year-old patient has a blood pressure of 138/85 on three occasions. The patient
denies
headaches, palpitations, snoring, muscle weakness, and nocturia and does not take any
medications. What will the provider do next to evaluate this patient?
a. Assess serum cortisol levels
b. Continue to monitor blood pressure at each health maintenance visit
c. Order urinalysis, CBC, BUN, and creatinine
d. Refer to a specialist for a sleep study - ANSWERS-ANS: C
This patient has pre-hypertension levels and should be evaluated. UA, CBC, BUN, and
creatinine help to evaluate renal function and are in the initial workup. Serum cortisol
levels are performed if pheochromocytoma is suspected, which would cause headache.
The patient does not have snoring, so a sleep study is not indicated at this time. It is not
correct to continue to monitor without assessing possible causes of early hypertension.
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