NSG6001 Midterm Exam / NSG 6001 Midterm Exam (2019): South University (Already graded A)
NSG6001 Midterm Exam / NSG 6001 Midterm Exam: South University
South University NSG6001 Midterm Exam / South University NSG 6001 Midterm Exam
Question 1. Question :
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?
xFramingham risk score
Do not exist
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
What happens to coronary flow related to CAD?
Hyper profusion of the myocardium
Cerebral vascular infarction
xHypo profusion of the myocardium
Functional systolic pressures
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
To please the patient
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?
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
Rise in heart rate without evidence of ischemia
Weak ventricular muscles
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
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
Produces QRS changes that cannot be interpreted
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
A smoker of 3 weeks
A member of congress
What is the leading cause of death for women in the United States?
Complications of childbirth
In women, you need to know the limitations of certain tests for CAD. For example, single-photon emissions CT imaging, while an acceptable test for most men and some women, is technically limited in women for two reasons. From the following, choose the best possible answer.
Smoking rates and lack of uptake of photons
Multiple vessel disease and fat deposits
Breasts and fat deposits in abdomen
xBreasts and smaller coronary arteries
Question 12. Question :
What are two of the most common forms of Exercise Stress Tests used today?
Unicycle and Running in pace
Thallium and Dobutamine
Bicycle and rowing machine
xBicycle and treadmill
Question 13. Question :
Improvements in the delivery and management of healthcare are necessary if we are to improve the overall health of this nation’s population. Which of the following are identified in your readings as strategic in the movement to improve the healthcare system?
Socialized medicine and governmental controls
xPopulation management and healthcare practice
Monetary savings and limited disruption in healthcare delivery
President and Congress
Question 14. Question :
For women with known CAD and diabetes, which is most appropriate to assess CAD risk?
xETT with imaging
Coronary bypass surgery
Question 15. Question :
What is considered the first-line initial approach to test for CAD?
xExercise Stress Test
Encouragement of patients to take effective actions in their own healthcare refers to the concept of:
Family care givers
Physician or provider-driven care
Question 17. Question :
Ischemic changes on ECG during ETT is highly predictive of CAD. What is another important strong predictor of CAD that you might see during an ETT?
Rapid heart rate
Slow heart rate
Question 18. Question :
Maintenance of an Isoelectric ST-segment during exercise is the response of?
An abnormal heart
xA normal heart
Question 19. Question :
What ECG changes can reduce the specificity of the ETT?
Paced rhythm and exercise induced bundle branch blocks
Exercise induced bundle branch blocks
Low voltage up sloping of the ST-segment
xPaced rhythm and resting bundle branch block
Question 20. Question :
Your patient has a maximum age-predicted heart rate of 180. During the exercise, he reaches a heart rate of 140 and then states he can no longer exercise. You see no evidence of ischemia on the ECG. This would be diagnostic for what condition?
Predictive of no CAD
Diagnostic of laziness
xHas no diagnostic value to rule out CAD
Diagnostic for impending Myocardial Infarction
Question 21. Question :
We all know that collaboration is integral to becoming a successful nurse practitioner. Among collaborations, however, only one can be considered as the most important. While each example below is important, which is the most important collaboration? The one that occurs:
Between the nurse practitioner and their physician mentor
Between two healthcare providers about a single patient
Between the patient and their family
xBetween the patient and the nurse practitioner
Question 22. Question :
As patients that entrust our care to another individual, we always expect honesty to avoid leading us down a deceptive pathway in our healthcare decisions. Adherence to which principle compels providers to be truthful?
xVeracity Adherence to veracity compels providers to be truthful with patients.
Question 23. Question :
What do you know regarding ischemia that is confined to only the posterior and or lateral segments of the left ventricle?
Easier to detect by ETT
Requires both for detection of changes by ETT
xDifficult to detect by ETT
ETT cannot be used for detection
Question 24. Question :
Your patient is morbidly obese and cannot sit on a bicycle or walk a treadmill. She also has marked and severe emphysema. You need to make an assessment of the risk of significant CAD and your patient’s family says that their relative had their diagnosis based on an ultrasound echocardiography. What facts would influence your decision regarding the family request for echo assessment?
Specificity would be reduced because of obesity and lung disease
Specificity would be increased because of obesity
Sensitivity would be increased because of lung disease
xSensitivity would be reduced because of obesity and lung disease
Question 25. Question :
Your mentor says that you should be prepared to know how to determine the maximum heart rate for your patient during the ETT. How is the age-predicted maximum heart rate during an ETT determined?
Question 26. Question :
You are considering adding an adjunctive form of testing to detect wall motion abnormalities during the ETT. You select Echocardiography as the added testing. You choose this test because you know that echocardiography does what when added to a standard ETT?
xEnhances sensitivity and specificity of CAD detection
Enhances sensitivity while reducing specificity of CAD detection
Enhances specificity while not changing sensitivity of detection for CAD
You like pretty pictures of wall motion
Question 27. Question :
Your patient underwent an exercise stress test for CAD. There is significant elevation of the ST-segment. What do you need to know about these changes to manage your patient’s care?
xThese changes have minimal predictive value for CAD
This patient needs to see someone more experienced in treatment of CAD
These changes are predictive of myocardial infarction
These changes predict dire outcomes
Question 28. Question :
The sensitivity of a routine ETT is effort dependent. What physiological changes occur during effort in the routine ETT?
Rapid heart rates and coronary artery narrowing
xIncreased coronary flow and increased systolic blood pressure
Decrease in coronary blood flow
Decreased heart rate and increased systolic blood pressure
Question 29. Question :
What purpose does the principle of fidelity serve in the provider/patient relationship?
xEnsures that providers honor their commitments to the patient
Obligates the provider to a one-on-one relationship with the individual
Ensures that patients receive whatever they want
Maintains costs in the healthcare arena
Question 30. Question :
A 55-year old man is referred to your clinic. He has been sedentary all of his life, is gaining weight and wishes to get into better physical shape. He has never had any chest pain or shortness of breath when walking or climbing a flight of stairs. Before recommending a vigorous exercise routine for this patient, you order what test?