Question 1

In mitral stenosis,p waves may suggest:

Accepted Answer

In mitral stenosis, there is obstruction of blood flow from the left atrium to the left ventricle. This leads to an increase in pressure in the left atrium, causing enlargement of the chamber. This can be seen on an electrocardiogram as an enlarged P wave, also known as a P mitrale. Therefore, choice A, left atrial enlargement, is the best choice.

Question 2

What is the most common valvular heart disease in the older adult?

Accepted Answer

Aortic stenosis is the most common valvular heart disease in older adults, with prevalence increasing with age. Aortic regurgitation and mitral regurgitation are also common, but less so than aortic stenosis. Mitral stenosis is uncommon in developed countries due to the decreased incidence of rheumatic fever.

Question 3

The best way to diagnose structural heart disease/dysfunction non-invasively is:

Accepted Answer

Echocardiogram is the best non-invasive method to diagnose structural heart disease/dysfunction as it can provide detailed images of the heart's structures and how they are functioning. Chest x-rays and EKGs can provide some information, but they are not as comprehensive as an echocardiogram. Heart catheterization is an invasive procedure that is usually only done if non-invasive tests are inconclusive or further information is needed.

Question 4

Susan P. ,a 60-year-old woman with a 30 pack year history,presents to your primary care practice for evaluation of a persistent,daily cough with increased sputum production,worse in the morning,occurring over the past three months.She tells you,"I have the same thing,year after year." Which of the following choices would you consider strongly in your critical thinking process?

Accepted Answer

The patient's history of smoking (30 pack year history) and persistent cough with sputum production for three months strongly suggest chronic bronchitis, a type of chronic obstructive pulmonary disease (COPD). While seasonal allergies, acute bronchitis, and bronchial asthma may also cause cough and respiratory symptoms, the chronicity of the patient's symptoms and smoking history make chronic bronchitis the most likely diagnosis.

Question 5

Ischemic heart disease is:

Accepted Answer

Ischemic heart disease is defined as an imbalance between oxygen supply and demand in the heart muscle. This can lead to symptoms such as angina (chest pain or discomfort) and is a leading cause of death, especially in the elderly. Therefore, all of the choices are correct.

Question 6

The aging process causes what normal physiological changes in the heart?

Accepted Answer

The heart valve does thicken and become rigid, which is caused by fibrosis and sclerosis due to the aging process.

Answer: C 
 Dilation of the right ventricle occurs with sclerosis of pulmonic and tricuspid valves, which is caused by the aging process.

Answer: D 
 Hypertrophy of the right ventricle may occur due to conditions such as pulmonary hypertension, but it is not typical of the normal physiological changes that occur with aging. Therefore, this option is not the best choice.

The best choice(s) based on typical changes that occur with the aging process in the heart are A and C.

Question 7

Preceding a stress test,the following lab work might include:

Accepted Answer

CBC and differential can help differentiate ischemic heart disease (which may cause chest pain) from anemia (which can also cause fatigue and weakness). Thyroid studies can help rule out hyperthyroidism, which can also present with symptoms (such as palpitations) that may mimic heart disease. Liver enzymes and gall bladder disease are not directly related to a stress test for heart disease, so choice B is not necessary.

Question 8

Jose M.is a 68-year-old man who presents to your primary care practice for a physical.Jose has had type 2 diabetes mellitus for 5 years,diet controlled.His BMI is 32.Smoker,  pack per day for 25 years.He denies other medical problems.Family history includes CAD,CABG x4 for father,now deceased;CHF,type 2 diabetes mellitus,HT for mother.According to the AHA/ACC guidelines,what stage is Jose?

Accepted Answer

The answer of Jose M.is a 68-year-old man who presents...

Question 9

The best evidence rating drugs to consider in a post myocardial infarction patient include:

Accepted Answer

The drugs with the highest evidence rating for post myocardial infarction patients are ASA, ACE/ARB, beta-blocker, and aldosterone blockade. These medications have been shown to decrease the risk of future cardiovascular events and are recommended by numerous guidelines such as the American College of Cardiology/American Heart Association Guidelines. Ace inhibitors and ARBs improve cardiac function and decrease blood pressure, while beta-blockers reduce heart rate and blood pressure. Aldosterone blockade reduces salt and water retention and decreases the risk of developing heart failure after a myocardial infarction. Calcium channel blockers and long-acting nitrates may be considered in some patients, but they do not have as strong of evidence as the medications listed in option A. Warfarin and clopidogrel may be considered in specific patients based on their individual risk factors, but they are not routinely recommended for all post myocardial infarction patients.

Question 10

An older adult may present with atypical clinical signs of pneumonia.The nurse practitioner needs to be aware that the clustering of all of the following signs and symptoms may be indicative of pneumonia in an older person except:

Accepted Answer

Bradycardia is not typically seen as a sign of pneumonia in older adults. Instead, tachycardia may be present due to the body's increased effort to fight off the infection. Malaise, anorexia, and confusion can all be common signs of pneumonia in older adults, and should be monitored closely by the nurse practitioner.

Question 11

Which test is the clinical standard for the assessment of aortic stenosis?

Accepted Answer

Echocardiography is the clinical standard for the assessment of aortic stenosis. It allows for noninvasive evaluation of the severity and extent of stenosis, as well as assessment of the aortic valve structure and function. Cardiac catheterization may be used for further evaluation or intervention, but is not the initial standard test. Stress tests and chest x-rays may provide additional information, but are not specific for aortic stenosis.

Question 12

Which of the following statements is true concerning anti-arrhythmic drugs?

Accepted Answer

Many anti-arrhythmic drugs have a low toxic/therapeutic ratio, meaning that the dosage that is effective for treating arrhythmias is close to the dosage that can cause toxicity. Some anti-arrhythmic drugs, such as Class IA agents like procainamide and Class III agents like dronedarone, can be especially toxic. Therefore, careful monitoring and dosing is required when using anti-arrhythmic drugs. Choices A, B, and D are all incorrect. Amiodarone is not the only anti-arrhythmic drug without increased mortality, and it has many potential side effects. Long-acting calcium channel blockers like verapamil and diltiazem are not associated with increased cardiovascular morbidity and mortality. Finally, not all patients with arrhythmias need to be initiated on anti-arrhythmic therapy in the hospital.

Question 13

On examination,what type of murmur can be auscultated with aortic regurgitation?

Accepted Answer

An Austin Flint murmur is a low-pitched diastolic rumble heard at the apex, associated with severe aortic regurgitation due to the regurgitant flow striking the anterior leaflet of the mitral valve.

Question 14

Dan G. ,a 65-year-old man,presents to your primary care office for the evaluation of chest pain and left-sided shoulder pain.Pain begins after strenuous activity,including walking.Pain is characterized as dull,aching;8/10 during activity,otherwise 0/10.Began a few months ago,intermittent,aggravated by exercise,and relieved by rest.Has occasional nausea.Pain is retrosternal,radiating to left shoulder,definitely affects quality of life by limiting activity.Pain is worse today;did not go away after he stopped walking.BP 120/80.Pulse 72 and regular.Normal heart sounds,S1 and S2,no murmurs.Which of the following differential diagnoses would be most likely?

Accepted Answer

The presentation of exertional chest pain radiating to the left shoulder and relieved by rest is classic for angina pectoris, which is associated with coronary artery disease. The fact that the pain is also limiting the patient's activity and not relieved by stopping the activity further supports this diagnosis. Musculoskeletal chest wall syndrome and esophageal motor disorders could also cause chest pain, but they typically do not radiate to the left shoulder or worsen with exertion. Acute cholecystitis would present with right upper quadrant abdominal pain and would not be expected to cause chest pain radiating to the shoulder.

Question 15

Which test is the clinical standard for the assessment of aortic stenosis?

Accepted Answer

Echocardiography is the clinical standard for the assessment of aortic stenosis. It provides detailed information about the valve, including the severity of the stenosis, the valve area, and the function of the heart. Other tests may also be used to support the diagnosis, but echocardiography is the primary test.

Question 16

The organism most commonly responsible for community-acquired pneumonia in older adults is:

Accepted Answer

Streptococcus pneumonia is the most common cause of community-acquired pneumonia in older adults, as well as in children and younger adults. Pseudomonas aeruginosa is more commonly associated with hospital-acquired infections, and Staphylococcus aureus is more commonly associated with skin and soft tissue infections. Proteus mirabilis is not usually a cause of pneumonia.

Question 17

A key symptom of ischemic heart disease is chest pain.However,angina equivalents may include exertional dyspnea.Angina equivalents are important because:

Accepted Answer

Angina equivalents, such as exertional dyspnea, are important because women with ischemic heart disease may not have chest pain as their primary symptom, and some patients may present with atypical symptoms or no symptoms at all. This can lead to a delay in diagnosis and treatment, and in some cases, diagnosis may only be made at the time of an actual myocardial infarction. Elderly patients may also have more severe symptoms, but this is not directly related to the importance of angina equivalents.

Question 18

A common auscultatory finding in advanced CHF is:

Accepted Answer

S3 gallop rhythm is a common finding in advanced CHF and indicates a decrease in left ventricular compliance.

Question 19

A 55-year-old post-menopausal woman with a history of hypertension complains of jaw pain on heavy exertion.There were no complaints of chest pain.Her ECG indicates normal sinus rhythm without ST segment abnormalities.Your plan may include:

Accepted Answer

The patient's symptoms and risk factors suggest a possible coronary artery disease, and an exercise stress test can help evaluate the patient's cardiac function and detect any abnormalities that may indicate a need for further testing or treatment. An echocardiogram, cardiac catheterization, or myocardial perfusion imaging may be considered based on the results of the stress test. However, the stress test is the most appropriate screening test for this patient at this stage.

Question 20

Aortic regurgitation requires medical treatment for early signs of CHF with:

Accepted Answer

The answer of Aortic regurgitation requires medical treatment for early...

Quiz 8: Chest Disorders

In mitral stenosis,p waves may suggest:

What is the most common valvular heart disease in the older adult?

The best way to diagnose structural heart disease/dysfunction non-invasively is:

Ischemic heart disease is:

The aging process causes what normal physiological changes in the heart?

Preceding a stress test,the following lab work might include:

The best evidence rating drugs to consider in a post myocardial infarction patient include:

An older adult may present with atypical clinical signs of pneumonia.The nurse practitioner needs to be aware that the clustering of all of the following signs and symptoms may be indicative of pneumonia in an older person except:

Which test is the clinical standard for the assessment of aortic stenosis?

Which of the following statements is true concerning anti-arrhythmic drugs?

On examination,what type of murmur can be auscultated with aortic regurgitation?

Which test is the clinical standard for the assessment of aortic stenosis?

The organism most commonly responsible for community-acquired pneumonia in older adults is:

A key symptom of ischemic heart disease is chest pain.However,angina equivalents may include exertional dyspnea.Angina equivalents are important because:

A common auscultatory finding in advanced CHF is:

A 55-year-old post-menopausal woman with a history of hypertension complains of jaw pain on heavy exertion.There were no complaints of chest pain.Her ECG indicates normal sinus rhythm without ST segment abnormalities.Your plan may include:

Aortic regurgitation requires medical treatment for early signs of CHF with: