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NUR6550 Final Exam Question 1. The Valsalva maneuver and the squat-to-stand maneuver are likely to increase the sound of a cardiac murmur associated with which of these conditions? Hypertrophic cardiomyopathy 2. Which of ...

NUR6550 Final Exam Question 1. The Valsalva maneuver and the squat-to-stand maneuver are likely to increase the sound of a cardiac murmur associated with which of these conditions? Hypertrophic cardiomyopathy 2. Which of the following conditions may result in lower extremity edema? Nephrotic syndrome Decompensated congestive heart failure Cirrhosis Renal failure Deep venous thrombosis Late-stage pregnancy All of the above 3. Art Bakke is a 46-year-old male who is being treated for an acute myocardial infarction. He has now developed significant dyspnea at rest and, per physical exam, has coarse rales involving the lower 2/3 of the lung fields bilaterally. You suspect acute pulmonary edema due to papillary-muscle rupture and acute mitral-valve regurgitation. Question: Which of the following physical findings would support this diagnostic hypothesis? A palpable diastolic murmur maximal in the second intercostal space (ICS) at the left sternal border A harsh, rumbling, diastolic murmur heard maximally in the fourth ICS at the left sternal border A holosystolic systolic murmur heard maximally in the fifth ICS at the midclavicular line 4. The most common ECG finding in a patient with a cardiomyopathy is an ST-elevation MI. True False 5. Nina Martinez is a 70-year-old female who experienced an episode of acute pulmonary edema following an endovascular aneurysm repair. She was discharged on furosemide 60 mg daily and instructed to follow up with cardiology. She is now seen in the office at 2 weeks post discharge. Her metabolic panel includes the following lab values: • Na 126 mEq/L • K 4.0 mEq/L • Cl 93 mEq/L • CO2 28 mEq/L • BUN 40 mg/dL • Cr 1.3 mg/dL Question: This patient has which of the following abnormalities as a likely consequence of diuretic overuse? Hyponatremia Hypokalemia Metabolic acidosis 6. Which of the following are primary cardiomyopathy categories, as described by the World Health Organization (WHO) in 1995? Dilated cardiomyopathy Symbol Hypertrophic cardiomyopathy (HCM) Symbol Restrictive cardiomyopathy Symbol Arrhythmogenic right ventricular dysplasia Symbol Unclassified All of the above 7. What is the most common cause of sudden cardiac death in young people? What is the most common cause of sudden cardiac death in young people? Myocardial infarction Hypertrophic cardiomyopathy Supraventricular tachycardia Arrhythmogenic right ventricular dysplasia; aka arrhythmogenic right ventricular cardiomyopathy (ARVC) 8. Which of the following are treatment options for a patient who presents with peripartum cardiomyopathy while still carrying the fetus? (Select all that apply.) ACE inhibitors Induction if stable Emergent cesarean section if unstable Digoxin Nitroglycerin 9. What are the 3 major clinical complications related to cardiomyopathies? Arrhythmias; including ventricular tachycardia and ventricular fibrillation Thromboembolic complications; including DVT, PE, and ventricular thrombi Acute pulmonary edema 10. Some patients with primary cardiomyopathies remain asymptomatic throughout their lifetime. True False 11. A 38-year -old woman comes to the emergency department complaining of a rapid heartbeat, tremors, and chest tightness. She reports earlier in the day she was feeling a migraine starting so she took a pill given to her by her friend who also experiences migraines. Her medical history reveals that she is currently taking a monoamine oxidase inhibitor for depression. Which migraine medication did she most likely take? Acetaminophen and caffeine (Excedrin ® Migraine) Naproxen sodium (Aleve ® ) Almotriptan (Axert ® ) Butalbital, acetaminophen and caffeine (Fioricet ® ) 12. You are seeing a 68-year-old woman for treatment of an uncomplicated urinary tract infection (UTI). She has well-controlled hypertension, type 2 diabetes mellitus, and dyslipidemia and takes an angiotensin-converting enzyme inhibitor (ACEI), statin, biguanide, and low-dose aspirin (ASA). She worked in a dry cleaning facility until approximately 8 years ago. During her evaluation, she mentions that she sometimes has difficulty understanding conversation, especially in noisy environments. This is likely a: Drug-related reaction. Consequence of occupational chemical exposure. Early sign of dementia. Normal age-related change in hearing 13. While evaluating a 33-year-old female with a 2-day history of dysuria, which of the following findings in urinalysis is most suggestive of urinary tract infection (UTI) caused by a Gram-negative organism? Nitrites 30 mg/dL protein Epithelial cells pH>8 14. All of the following are examples of primary prevention strategies except: Counseling an elderly patient prior to discharge about fall risk at home and how to prevent falls through adequate illumination. Performing a hemoglobin A1C for all patients admitted to the hospital. Conducting a study to identify the leading cause of mortality in teenagers and how to reduce risk. Immunizing all adults ?60 years with zoster vaccine. 15. A 23-year-old woman is being evaluated for an upper respiratory tract infection. As you prepare for auscultation, the patient states “I have a benign murmur that has been with me my whole life”. Anticipating a physiologic murmur, you would expect which of the following characteristics? Usually obliterates S2. Becomes softer when going from a supine to standing position. Occurs late in systole. Has localized area of auscultation 16. You see a 73-year-old woman with a 40 pack- year smoking history, chronic obstructive pulmonary disease (COPD) and peripheral arterial disease (PAD) who presents with an ulcer on the sole of her left foot. The ulcer has an irregular edge and pale base and a punched out appearance, with the surrounding skin white and shiny. The patient states that the pain is worse at night in bed and when the legs are elevated. The most likely diagnosis is: Pressure ulcer Pyoderma gangrenosum Venous ulcer Arterial ulcer 17. You see a 76-year-old woman living at home who is accompanied by her home care provider. She has COPD and type 2 diabetes mellitus. An example of a secondary prevention strategy is: Administering the seasonal influenza vaccine. Screening for physical or financial abuse/Checking her blood glucose level. Checking her blood pressure. Adjusting her insulin dosing regimen. 18. A 43-year-old woman is being evaluated in the emergency department with a complaint of a severe headache. She describes a unilateral, pulsing headache that was preceded by a gradual onset of paresthesia affecting the ipsilateral face and arm. The patient stated she noticed a “funny smell” prior to the symptoms starting. This description is most typical of: Migraine with aura. Cluster headache. Transient ischemic attack. Tension-type headache.