Download AANP FNP Review - CV & Pulmonary Latest Exam With Correct Verified Answers 2025-2026 and more Exams Nursing in PDF only on Docsity!
AANP FNP Review - CV & Pulmonary Latest Exam
With Correct Verified Answers 2025- 2026
Deoxygenated: Superior vena cava → right atrium → tricuspid valve → right ventricle → pulmonary valve → pulmonary arteries → lungs (RBCs pick up oxygen and release carbon dioxide in alveoli). Oxygenated: Pulmonary vein → left atrium → mitral valve → left ventricle → aortic valve → body - correct answer>>Cardiac blood flow Sudden onset severe chest/back pain, increasingly sharp & excruciating; pulsating-type sensation in abdomen or lower back pain. On exam, distended abdomen with hypotension. Diagnostics: abd US; and incidental CXR (may find widened mediastinum, tracheal deviation, obliteration of aortic knob). - correct answer>>Dissecting abdominal aortic aneurysm: s/s & diagnostic Risks: male >60y, smoker, uncontrolled HTN, white race, & genetic disease (such as Marfan syndrome). Tx: surgical; or if <4cm monitor CT annually - correct answer>>Dissecting abdominal aortic aneurysm: risks & tx Normal: resonance to percussion, vesicular (lower lobes), bronchial (upper lobes), tracheal (over trachea). Air trapping: hyperresonance to percussion, decreased tactile fremitus, wheeze (1st expiratory, later inspiratory), low diaphragm, increase AP diameter. - correct answer>>Breath sounds: normal & abnormal expiration Consolidation: dullness to percussion; increased tactile fremitus (say 99); egophony (eee sounds like ah); bronchial or tubular breath sounds & often with late inspiratory crackles that don't clear with cough. XR white area. Pleural inflammation: Sharp localized pain (worse with deep breath, movement, & cough) or pleural friction rub (audible, heard on inspiration & expiration, sounds like stepping in fresh snow). - correct answer>>Breath sounds: abnormal inflammatory Untreated/undertreated hypothyroidism, poorly controlled diabetes, & excessive alcohol use. - correct answer>>Secondary Hypertriglyceridemia Cough lasting longer than 14d plus either paroxysmal cough or inspiratory "whoop" (no cause). Can last months, most contagious early in disease. 3 stages: catarrhal (1-2wk,
low grade fever, rhinorrhea, mild cough), paroxysmal (2-4wk, cough or whoop), & convalescent (1-2 wk). Tx: give abx 1st line macrolides (#1 azithromycin; then erythromycin, clarithromycin), alternate (bactrim); prophylaxis abx to close contacts within 3wk exposure. - correct answer>>Pertussis Cough (non-productive), dyspnea, paroxysmal nocturnal dyspnea, orthopnea. Left side exam: crackles bibasilar, S3 heart sound, dullness to percussion, & wheeze ("left = lung"). Right side exam: JVD (normal <4cm), enlarged spleen, enlarged liver causing anorexia, nausea, & abd pain, & lower extremity edema ("right = GI"). - correct answer>>Congestive Heart Failure: HF s/s Cause/risk: MI, CAD, HTN, fluid retention, valvular abnormalities, & arrhythmias. Meds that contribute to HF: amlodipine, metoprolol (but they need it), actos/Avandia (glitazone), & NSAIDs. - correct answer>>Congestive Heart Failure: HF risk C (confusion, new onset) U (Urea, BUN >19) R (RR>=30) B (SBP <90 or DBP <60) 65 (age 65 & up). PNA tool: score 0-1 OP mgt; score 2 close OP or hospital; score 3-5 IP hospital. - correct answer>>CURB 65 Diagnostics: Chest x-ray, (Kerley B lines) EKG, CPK, troponin, BNP, CMP, echo [EF <40% systolic failure (HFrEF) & EF >40% diastolic failure (HFpEF)]. Plan: diuretic (relieve volume overload); for stable HFrEF (ACEI/ARB 1st line) or decompensated HFrEF (start low dose BB after pt has started ACEI/ARB/ARNI); lifestyle (limit sodium intake 2-3 g/d & fluid restrict 1.5-2L/d); monitor weight daily, avoid ETOH, stop smoking; use NYHA classification. Refer or coordinate cardiology (HF best managed by cardiologists or at a heart clinic). - correct answer>>Congestive Heart Failure: diagnostic & plan Drugs "olol" - Atenolol, metoprolol Action: block beta1 receptors in heart; lowers HR & stroke volume; reduces effects of circulating catecholamines. Indicated: more common for HF than HTN (4th line HTN - whites better SBP control than blacks); MI, migraines, glaucoma, resting tachycardia, angina, hyperthyroidism. DO NOT USE contraindicated (heart block & bradycardia). Avoid with asthma & COPD (monitor for worsening). - correct answer>>Congestive Heart Failure: treatment BB
Red Zone: <50% (breathing hard & fast, nasal flaring, trouble speaking. In children, ribs show from using accessory muscles. Administer oxygen. First-line treatment is albuterol by MDI with spacer or nebulizer. Onset of action <5 minutes. If not effective, call 911). - correct answer>>Asthma action plan Abrupt onset rapid HR (150-250), palpitations, lightheadedness, SOB, & anxiety. Common causes digitalis toxicity, alcohol, hyperthyroidism, caffeine, illegal drugs, & Wolf Parkinson White Syndrome (WPW). Tx: vagal maneuvers, carotid massage, & ice water to face. ED if WPW or symptomatic. - correct answer>>Paroxysmal supraventricular tachycardia (PSVT) Episodes of numbness/tingling in fingers/toes; color changes, white (pallor) blue (cyanosis) red (reperfusion); can last several hours. Reversible vasospasm of peripheral arterioles in fingers/toes (check distal pulses). May cause small ulcers on fingers/toes. Increased risk of autoimmune d/o (thyroid d/o, scleroderma, & rheumatoid arthritis) or pernicious anemia. More common in women, age 15-45y. Tx: avoid triggers (cold weather, cold objects, stimulants, & smoking), CCB or ACEI, beta blockers, & drugs vasoconstriction. - correct answer>>Raynaud's phenomenon Sudden onset dyspnea & coughing (cough may be productive, pink-tinged frothy sputum), tachycardia, pallor, & feelings of impending doom (may report abrupt onset chest pain, dyspnea, dizziness, or syncope). Tachypnea is most common presentation. Risks: smoking, Afib, estrogen therapy, surgery, prolonged inactivity, cancer, pregnancy, & long bone fractures. - correct answer>>Pulmonary embolism (PE) Leg aching, mild edema (end of day & warm weather), superficial veins tortuous & dilated, commonly saphenous vein. Causes/factors: women, inherited, crossing legs, constrictive clothing, prolonged standing, heavy lifting. Tx: laser venous ablation, sclerotherapy, surgery. - correct answer>>Varicose veins Unilateral finding on lung exam warrants order for CXR. Views: AP (thru back) PA (thru front of chest). Findings: air appears black (low density, low absorption), bone appears white, metals appear bright white ((high density, high absorption), tissue appears different grayish shades (medium absorption) with visible tissues (trachea, bronchus, aorta, heart, lungs, pulmonary arteries, diaphragm, gastric bubbles, ribs), fluids appear grayish to white, and f/u required if hilar nodes are visualized. - correct answer>>CXR MR Peyton Manning AS MVP (pneumonic)
MR (mitral regurgitation - loudest at mitral, apex/apical/PMI/ L sternum 5th intercostal space ICS midclavicular line MCL, pansystolic/holosystolic, radiates to axilla, loud or high pitched blowing use diaphragm. Mitral valve incompetent, doesn't close properly, leads to decreased cardiac output) Peyton Manning (physiologic murmur - louder when lying down, r/t hemic such as anemia or dehydration). - correct answer>>Systolic murmurs: MR & PM MR Peyton Manning AS MVP (pneumonic) AS (aortic stenosis - loudest at aortic, upper R sternum 2nd ICS, radiates to neck, harsh/noisy use diaphragm. Most common to arise d/t aging. Causes include LVH, rheumatic fever, angina, CHF. Monitor ECHO, valves. Risk syncope, cardiac death so avoid physical exertion). MVP (mid to late, midsystolic click). - correct answer>>Systolic murmurs: AS & MVP Intermittent (FEV1>80%P, P means predicted) s/s <=2d/wk. Mild (FEV1>80%P) s/s >2d/wk (NOT daily), night 3-4/mo, & minor activity limitation. Moderate (Most common, FEV1 60-80%P) s/s daily, night >1/wk, some activity limitation. Severe (FEV1 <60%P) s/s through day, night 7/wk, & extreme activity limitation. - correct answer>>Asthma classifications S1 systole: Motivated M (mitral) T (tricuspid) AV (atrioventricular) - closure of AV- mitral/tricuspid valves makes lub sound. S2 diastole: Apples A (aotric) P (pulmonic) S (semilunar) - closure of semilunar- aortic/pulmonic valves makes dub sound. Split S2: best heard pulmonic area, normal in healthy athlete. - correct answer>>Heart sounds: S1 & S S3: best heard pulmonic area, sounds like Kentucky (ventricular or S3 gallop); pathologic age >35y, #1 CHF or thyrotoxicosis. Normal in young healthy athletes & pregnancy. S4: best heard at apex use bell (occurs late diastole), sounds like Tennessee (atrial gallop or kick) #1 LVH, HTN poorly controlled, or unstable angina. Normal in some elderly. Stethoscope: use bell for low pitch tones (S3, S4, mitral stenosis) and use diaphragm for mid to high pitch tones (lung sounds, mitral regurgitation, & aortic stenosis). - correct answer>>Heart sounds: S3 & S As needed, step up (address adherence) & reassess in 2-6wk. Step 1 (intermittent) SABA (alb or levalbuterol) Step 2 low dose ICS (Budesonide-formoterol/Symbicort or Salmeterol- fluticasone/Advair)
Labs: elevated AST & ALT with negative Hep A, B, & C. Tx - avoid or reduce risk such as weight loss, diet, avoid alcohol & certain drugs (hepatotoxic - statins, tylenol). Refer to GI (gold standard liver biopsy). - correct answer>>Non-alcoholic fatty liver disease (NAFLD) Fall in SBP more than 10mmHg during inspiration. Apical pulse audible, even though radial pulse is no longer palpable. Measured through stethoscope and BP cuff. Chambers of the heart are compressed, causing exaggerated decrease in systolic BP <10mmHg. AKA paradoxical pulse. Occurs with conditions that can impair diastolic filling & an increased intrathoracic pressure during inflammation. Common causes pulmonary (asthma, emphysema) and cardiac (tamponade, pericarditis, & cardiac effusion). - correct answer>>Pulsus paradoxus Growth failure children, glaucoma, cataracts, immune suppression, Hypothalamic- pituitary-adrenal (HPA) suppression, osteoporosis (Ca 1200mg +Vit D daily post- menopause). - correct answer>>Chronic steroid use Fatigue, palpitations, chest pain, & lightheadedness. Can be triggered by heavy exertion. May be asymptomatic. On exam, S2 "click" mid-late systolic murmur. Linked with pectus excavatum, hyper-mobility joints, arm span greater then height (Marfan's syndrome). Increased risk for thromboemboli, TIA, AF, & ruptured chordae tendineae. Diagnosed by cardiac ECHO with doppler flow study. Tx: asymptomatic (none); palpitations (beta blocker, avoid caffeine, cigarettes, & alcohol), arrhythmias (Holter monitor). - correct answer>>Mitral valve prolapse (MVP) Chest discomfort, SOB, hemoptysis, cough. High risk: age 55-74 with hx smoker 30 pack/yr &/or quit within 15yr; age 50 high risk smokers. Screen: chest CT annual for high risk persons (limitations include high false positive rate, radiation exposure, & pt anxiety). - correct answer>>Lung cancer SVT (most common) leads to stroke. Atrial fibrillation: HR>110 palpated, may be asymptomatic; HD unstable 911/ED (chest pain, hypotension, HF, cold clammy skin, AKI). Paroxysmal Afib - episodes terminate in less than 7d. - correct answer>>Cardiac arrhythmias: s/s Anticoagulant for CHADS-VASC >=
C (CHF) H (HTN) A (age >75y) D (DM) S (stroke/TIA) V (vascular disease) A (age 65-74y) S (sex F), & C (check need for CCB, BB, digoxin to regulate HR). Warfarin INR 2-3 (Afib) & INR 2.5-3.5 (valves). INR >4-5 (hold 1 dose &/or reduce maintenance dose). - correct answer>>Cardiac arrhythmias: treatments Risk factors: HTN, CAD, ACS, caffeine, nicotine, hyperthyroidism, alcohol, HF, LVH, PE, COPD, OSA (sleep apnea). Tests: EKG, TSH, electrolyte, renal fx, 24h Holter monitor, ECHO. - correct answer>>Cardiac arrhythmias: diagnostics ICS preferred (daily use optimal) for persistent asthma (mild, mod, severe): Beclomethasone/QVAR (low 80-240, medium >240-480, high >480mcg) Budesonide/Pulmicort (low 180-540, med >580-1080, high >1080mcg) Fluticasone/Flovent (low 88-264, med >264-440, high >440mcg) Mometasone/Asmanex (low 100-300, med >300-500, high >500mcg) - correct answer>>Asthma inhaled: ICS ICS+LABA (consistent daily use required) for mod-severe persistent: Budesonide + formoterol/Symbicort (low 180-540, med >580-1080, high >1080mcg) Fluticasone + salmeterol/Advair (low 88-264, med >264-440, high >440mcg) - correct answer>>ICS inhaled: ICS + LABA Always abnormal. ARMS (pneumonic) AR (aortic regurgitation - high pitched blowing use diaphragm, loudest at aortic 2nd ICS R sternum, valve incompetent fails to close) MS (mitral stenosis - low pitched "opening snap" crescendo use bell, loudest apex 5th ICS L sternum; commonly rheumatic fever). - correct answer>>Diastolic murmurs Furosemide/Lasix & Bumetanide/Bumex. Inhibits kidney (loop of Henle) sodium-potassium-chloride pumps, increasing UOP. Monitor electrolytes (hypokalemia, hyponatremia, hypomagnesemia, hyperuricemia) & dehydration. Allergy to sulfa may have cross sensitivity with thiazide & loop diuretics; as well as others such as sulfa antibiotics, sulfasalazine, & some protease inhibitors (darunavir, fosamprenavir); & may also be sensitive to topical sulfas (ophthalmic drops) or topical silver sulfadiazine (Silvadene). - correct answer>>Congestive Heart Failure: treatment loop diuretics
Isoniazid (INH - give with pyridoxine Vit B6) 300mg daily Rifampin (RIF - monitor liver) Ethambutol (ETH - causes optic neuritis, avoid if abnormal vision) Pyrazinamide (PZA - monitor liver) 3x a week (check baseline liver functions) for 6-9mo. - correct answer>>TB: treatments Triad of muscle pain, weakness, & dark urine (muscle pain & aches persistent without associated muscular exertion). Acute breakdown of skeletal muscle and acute renal failure. Diagnostics: elevated CK, UA (myoglobinuria/proteinuria), BUN, creatinine, K+, EKG. - correct answer>>Rhabdomyolysis Acute onset of indurated vein (localized redness, swelling, & tenderness); usually located on extremities; afebrile, & normal vital signs. On exam, indurated cordlike vein feels warm & tender to touch, without swelling or edema. Inflammation of superficial vein d/t trauma or infx (S. aureus). Tx: NSAIDs, warm compresses, & elevation of limb - correct answer>>Superficial thrombophlebitis PCV 13: age 19-64 immunocompromised or asplenia; age 65 & older. PPSV23: age 19-64 asthma, COPD, smoker, or CVD; age 65 & older. - correct answer>>Pneumococcal vaccines Screen: fasting lipids [increased risk for heart disease age 40-75y (every 2-3yr), or if HLD (at least annually)] and No screen for age 76+ with no hx CVD (lack evidence of screen benefit). Labs: total cholesterol [normal (<200), borderline (200-239), high (>240)]; HDL [normal (>40 men & >50 women), cardio-protect (>60)]; LDL (normal 100); triglycerides [normal (<150), pancreatitis (>1000) & r/o metabolic syndrome, DM, familial, alcohol abuse, hyperthyroidism, kidney disease, medications. - correct answer>>Hyperlipidemia (HLD): screen & labs Lifestyle (1st line): exercise, lose weight, eat healthy fats, eliminate trans fats, decrease junk food, stop smoking, & DASH diet. Target is to lower LDL first (unless ↑ triglycerides >500) prescribe STATINS (1st line). Statins can cause memory loss, confusion. Baseline hepatic enzymes, then no further monitoring. Adverse effect: rhabdomyolysis & myositis. Risk for myositis (advanced age, low body weight with high-intensity statin therapy).
Avoid grapefruit juice with simvastatin, atorvastatin, lovastatin. Simvastatin interactions: grapefruit, fibrates, antifungals, macrolides, amiodarone. - correct answer>>HDL: treatment 1st High intensity: DM age 50-75y with LDL>70; severe primary hypercholesterolemia with LDL>190; very high risk ASCVD; or current clinical ASCVD. Moderate intensity: DM age 40-74y with LDL>70; age 40-75y with 10y ASCVD risk >7.5% & risk factors. Avoid high intensity age>80y, frailty, renal impaired, multiple comorbidities, & with fibrate. Moderate intensity preferred if high risk for adverse effects. - correct answer>>HDL: treatment CV risk For 21-75y with any type of ASCVD (e.g., CAD, PAD, stroke, TIA) give high-intensity statins such as atorvastatin 40 to 80 mg or rosuvastatin 20 to 40 mg. For adult with LDL >190 mg/dL (without ASCVD or DM) also candidate for high-intensity statin dosing. - correct answer>>HDL: treatment (memorize) If triglycerides >500, treat triglycerides first. Fenofibrates (1st line), niacin, lovanza, (triglycerides are raised by alcohol and sugar). Educate to avoid alcohol & tylenol (hepatotoxic). Fibrates (fenofibrate): side effects (dyspepsia, gallstones, myopathy, do not use in severe renal/hepatic disease); if high triglycerides, then fibrate can increase LDL. Niacin (niaspan): side effects (hyperglycemia, hyperuricemia, upper GI distress, hepatotoxic, flushing - minimized when aspirin taken 1h prior) contraindication (avoid with statins, higher risk of liver damage). - correct answer>>HDL: treatment triglycerides 1st Bile acid (cholestyramine, colestipol, colesevelam): side effects (constipation, ↓ absorption of other meds); less effective used alone. Cholesterol absorption (ezetimibe/zetia): side effects (diarrhea, joint pains, tiredness) contraindications (active liver disease, unknown reason ALT/AST elevated). - correct answer>>HDL: treatment triglycerides add-on Monitor for myalgias if on statin. Consider stopping cholesterol screen & tx at age 80, but if symptoms, statins are excellent at keeping atherosclerosis stable so can prevent MI or CVA. Risks: HTN, premature heart disease (women <65 and men <55) DM, dyslipidemia, low HDL, cigarette smoking, obesity, microalbuminuria, CAD, PAD. - correct answer>>HDL: risks
Brain: CVA/TIA (increased ICP). GI: N/V Lung: PE or if CHF (s/s volume overload) - correct answer>>Hypertension: target organ damage (TOD) Elevated BP (120-129/80); Stage 1 (>130-139/80-89); stage 2 (>140/90). HTN urgency (>180/120) NO target organ damage (TOD). HTN emergency (>180/120) with TOD. Isolated systolic HTN elderly (SBP >160) r/t loss recoil in arteries & increased PVR (start mono-therapy, preferred thiazide & CCB). - correct answer>>Hypertension: primary Age <30y work-up: severe HTN or acute rise in BP (previously stable), resistant HTN ( agents); malignant HTN. Renal: renal artery stenosis, polycystic kidney, CKD. Endocrine: hyperthyroidism, hyperaldosteronism (HTN, low K+, normal to elevated Na+), pheochromocytoma (labile ↑ BP with palpitations, anxiety, sweating, severe HA). Other causes: sleep apnea, coarctation of aorta. Labs: (kidneys: creatinine, GFR, UA) (endocrine: TSH, fasting blood glucose) (electrolyte: K+, Na+, Ca2+) (heart: cholesterol, HDL, LDL, triglycerides) (anemia: CBC) Baseline EKG and CXR. - correct answer>>Hypertension: secondary Assess ASCVD risk. Lifestyle 1st line for HTN, HLD, & DM. Educate wt loss, stop smoking, reduce Na <1.5g/d, maintain K (>3.5g/d), limit alcohol, omegas (cold water fish 3x/wk), DASH diet, & exercise. Diet sources: K+ (most fruits/veg); Mg (bean, whole grains, nuts); & omega 3 (ancovy, krill, salmon, flaxseed). - correct answer>>Hypertension: treatment 1st line Thiazides (HCTZ, Chlorthalidone, Indapamide, Chlorothiazide) Side effects: hyper (hyperglycemia, hyperuricemia, hypertriglyceridemia, & hypercholesteremia) and hypo (hypokalemia, hyponatremia, & hypomagnesemia). Women with HTN & osteopenia or osteoporosis should take thiazides, helps prevent bone loss by slowing down calcium loss (from the bone) and stimulating osteoclasts. - correct answer>>Hypertension: treatment thiazides (memorize side effects) ACEI/ARB (ACE "pril" enalapril, ramipril, benzapril, fosinopril) ARB ("artan" losartan, candesartan, olmesartan; irbesartan) Side effects: dry hacking cough, hyperkalemia, & angioedema. Contraindications (mod- severe kidney disease or renal artery stenosis). Preferred: HFrEF (1st line ACEI/ARB) and (diuretics, ARNI, BB) DM & CKD (1st ACEI/ARB & add thiazide or CCB)
African Am (thiazides or CCBs). - correct answer>>Hypertension: treatment ACEI/ARB Action: systemic vasodilation, slows HR. Works better at night. DHP (doesn't hurt pulse) decreases BP, named "pine" (nifedipine, amlodipine, felodipine) (nonDHP verapamil, diltiazem). NonDHP (decreases HR with little decrease in BP) diltiazem & verapamil. NEVER USE (contraindicated) with heart block, bradycardia, CHF. Avoid taking with grapefruit & macrolides. Side effects: HA, ankle edema, heart block, bradycardia, reflex tachycardia. First line for HTN African Americans. - correct answer>>Hypertension: treatment CCB Ratio weight to height. Higher muscle mass can have falsely elevated BMI. Underweight (<18.5) Normal (18.5- 2 4.9) Overweight (25-29.9) Obese (>30) with waist circumference (male >40; female >35) and waist to hip ratio (Male 1; female 0.8). - correct answer>>Body mass index (BMI) For diagnosis, 3 of the following: abd. obesity (weight circumference), HTN, hyperlipidemia (or ↑ triglycerides), and ↓ HDL (insulin insensitivity), fasting glucose
100, or dx diabetes. - correct answer>>Metabolic syndrome How long have you coughed? Acute <3wk - acute respiratory infx, exacerbation COPD or asthma, PNA, pleural effusion. Chronic >8wk - asthma, GERD, pertussis, atypical (walking/mycoplasma) PNA, chronic bronchitis, bronchiectasis, lung cancer, ACE I (1-2 wk of starting drug). - correct answer>>Cough work-up Gradual onset of swelling on lower extremity after prolonged sitting; painful, red, warm, swollen extremity. Thrombi developed from stasis, trauma, inflammation, or coagulation. - correct answer>>Deep vein thrombosis (DVT) Tests: + Homan's sign (lower leg pain with dorsiflexion of foot, low sensitivity, about 33% detection), CBC, platelets, PT/PTT, INR, d-dimer, chest x-ray, EKG ultrasound, Wells criteria Risks: stasis (prolonged bedrest or travel, CHF), coagulation d/o (Factor C deficiency,
Leiden ↑ coagulation), contraceptives, pregnancy, fracture, trauma, surgery, malignancy. - correct answer>>DVT: diagnostic (memorize risks)
PCN allergy: Clinda (600mg), Biaxin (500mg), Keflex, or macrolide. No prophylaxis for MVP, GU, GI procedures (no longer recommended). - correct answer>>Bacterial endocarditis: treatments First degree, AV block: (prolonged PR>0.2 seconds) If R is far from P, then you have 1st degree. Second degree, Type I (Wenckebach): (PR is progressively longer until it drops) Longer, Longer, Longer, drop; then you have WENCKEBACH. - correct answer>>Heart block 1 & 2 Second degree, Type II Mobitz II: (PR constant but drops QRS periodically) If a QRS don't get through, then you have MOBITZ II. Third degree, complete block: (no pattern between PR and QRS) If Ps & Qs don't agree; then you have THIRD DEGREE. - correct answer>>Heart block 3 & 4
