APEA 3P EXAM QUESTIONS AND ANSWERS WITH RATIONALES 2024/2025, Exams of Nursing

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APEA 3P EXAM QUESTIONS

AND ANSWERS WITH

RATIONALES 2024/

Which patient could be expected to have the highest systolic blood pressure? A 21-year-old male A 50-year-old perimenopausal female A 35-year-old patient with Type 2 diabetes A 75-year-old male D. Nearly 25% of the US population has hypertension. The greatest incidence is in older adults because of changes in the intima of vessels as aging and calcium deposition occur. Males of any age are more likely to be hypertensive than females of the same age. African American adults have the highest incidence in the general population. Among adolescents, African Americans and Hispanics have the highest rates. Hypertension occurs in 5- 10% of pregnancies. Mrs. Brandy is having contrast dye next week for a heart catheterization. What drug does NOT need to be stopped prior to her catheterization? Naproxen Furosemide Metformin Losartan D. Naproxen and furosemide should be stopped for 24 hours prior to the catheterization. Metformin should be stopped 48 hours prior to the catheterization. Furosemide is stopped because it contributes to volume depletion. NSAIDs like naproxen are withheld because of the impact on renal prostaglandin production. Metformin has been implicated in lactic acidosis when combined with contrast dye in an impaired kidney. In older adults, the three most common ailments are: hearing loss, vision loss, hypertension. hearing loss, hypertension, arthritis. depression, vision loss, hypertension. arthritis, hearing loss, depression. B. Hypertension and arthritis are the two most common ailments in older adults. Hearing loss occurs in half to almost 2/3 of older adults. The most common form is known as presbycusis. There is no consensus for the frequency of screening for hearing loss in older patients, but

insufficiency. However, ACE inhibitors can worsen renal insufficiency, so the patients must be monitored closely with lab tests for BUN, Cr, and potassium. Diabetes without proteinuria is not a specific indication for ACE inhibitors use, though they are used by some healthcare providers in this way. This is an off-label use.

An older adult who has hypertension and angina takes multiple medications. Which one of the following decreases the likelihood of his having angina? ACE inhibitor Beta blocker Diuretic Angiotensin receptor blocker B. The beta blocker slows down heart rate, depresses myocardial contractility, and decreases sympathetic stimulation. These decrease myocardial oxygen demand and improve angina symptoms. It is an excellent drug class to use to prevent symptoms of angina in patients who have underlying coronary artery disease. Calcium channel blockers are another class of medications that could be used to improve symptoms of angina. Orthostatic hypotension can be diagnosed in an older adult if the systolic blood pressure decreases: more than 20 points anytime after rising. more than 20 points within 3 minutes after rising. more than 20 points within 1 minute after rising. any degree drop if the patient becomes weak or dizzy. B. Orthostatic hypotension, also called postural hypotension, is diagnosed in older adults when the systolic blood pressure drops 20 mm Hg or more within 3 minutes of moving to a more upright position. Systolic blood pressure can be expected to decrease within one minute of moving to an upright position. Normally, the blood pressure returns to baseline within one minute of a position change and orthostatic hypotension does not occur. It is always abnormal when blood pressure decreases beyond one minute of moving to an upright position. Orthostatic hypotension can then be diagnosed. Moving to an upright position may be 1) lying to sitting or 2) sitting to standing. Additionally, if the systolic blood pressure does not meet these criteria, but the diastolic drops by 10 mm Hg or more with a position change, orthostatic hypotension can be diagnosed. Patients

years, acquired calcifications appear on a normal aortic valve and produce aortic stenosis.

A 75-year-old patient with longstanding hypertension takes an ACE inhibitor and a thiazide diuretic daily. He has developed dyspnea on exertion and peripheral edema over the past several days. This probably indicates: worsening hypertension. development of heart failure (HF). noncompliance with medication. acute myocardial infarction. B. The symptoms of dyspnea on exertion and peripheral edema are symptoms of HF. Long standing hypertension is a risk factor for HF. Acute myocardial infarction would result in acute symptoms, not development of symptoms over the past several days. Noncompliance with medication and fluid or sodium excess might result in peripheral edema and development of heart failure. A patient with newly diagnosed heart failure has started fosinopril in the last few days. She has developed a cough. What clinical finding can help distinguish the etiology of the cough as heart failure and not related to fosinopril? It is dry and nonproductive. It is wet and worse with recumbence. It is purulent and tachycardia accompanies it. Shortness of breath always results after coughing. B. The cough associated with fosinopril, an ACE inhibitor, is a dry, nonproductive cough that may be described as annoying. Its severity does not change with position or time of day. A cough associated with heart failure is wet, worse when lying down, and is usually described by patients as worse at night. Choice c is often associated with fever and probably reflects an infectious process like pneumonia. Which choice below would be the best choice for an 80-year-old patient whose blood pressure is 172/72 mm Hg? Chlorthalidone Amlodipine Monopril Acebutolol B. This patient has isolated systolic hypertension. According to many learned authorities, this is best treated with a long-acting calcium channel blocker, particularly the ones that end in "pine." These belong to the class of calcium channel blockers termed dihydropyridines. Thiazide diuretics are not potent enough to decrease this patient's blood pressure into normal range, and its effect is not additive when combined with calcium channel blockers. Which medication could potentially exacerbate heart failure (HF)? Naproxen

A patient is diagnosed with mild heart failure (HF). What drug listed below would be a good choice for reducing morbidity and mortality long term? Verapamil Digoxin Furosemide Metoprolol D. Metoprolol is a beta-blocker. Beta-blockers are known to reduce morbidity and mortality associated with HF. Verapamil is a calcium channel blocker. This class of medications is contraindicated because they decrease the contractility of the heart. Furosemide and digoxin will improve symptoms but not long-term outcomes. Their main benefit is in treating symptomatic patients. The lipid particle with the greatest atherogenic effect is: Cholester ol. HDL. LDL. triglycerides. C. LDL cholesterol promotes atherosclerosis via several different mechanisms. Consequently, LDL cholesterol tends to be the primary target when patients are treated pharmacologically for elevated lipid levels. Low HDL levels and elevated triglyceride levels can accelerate atherogenesis. A 77-year-old patient has had an increase in blood pressure since the last exam. The blood pressure readings are provided. If medication is to be started on this patient, what would be a good first choice (VS in image)? ACE inhibitor Beta blocker Calcium channel blocker Thiazide diuretic

C.

This patient is 77 years old and should have a goal blood pressure of < 150/90 mmHg according to JNC8. A thiazide diuretic is not a good first choice in this patient because it will not be potent enough to decrease blood pressure by about 20 points to get him to his goal. A long-acting calcium channel blocker is appropriate for patients who have isolated systolic hypertension and will be more likely to get this patient to goal pressure than HCTZ. Beta-blockers are no longer recommended first-line for uncomplicated hypertension. ACE inhibitors are very effective in patients who are high renin producers. Older patients tend to produce lower amounts of renin. The nurse practitioner is caring for an independent 74-year-old female who had acute coronary syndrome (ACS) about 6 weeks ago. What medications should be part of her regimen unless there is a contraindication? ASA and beta blocker ACE and beta blocker ACE, ASA, and beta blocker ACE, ASA, beta blocker, and statin D. After a myocardial event, an aspirin, ACE inhibitor, beta blocker, and statin should be dosed daily. The aspirin will provide anticoagulation; the ACE inhibitor, statin and beta blocker are associated with reduced morbidity and mortality if given soon after ACS. Mr. Smith is a 72-year-old patient who takes warfarin for chronic atrial fibrillation. His INR and CBC results are provided (CBC in the image, INR 4.0). The nurse practitioner should: stop the warfarin for the next 4 days and repeat the INR on day 5. admit to the hospital immediately. administer vitamin K and repeat INR in 2 hours. stop the warfarin today and repeat the INR tomorrow. D. An INR range of 2.0-3.0 is therapeutic for most people who take warfarin for chronic atrial fibrillation. An INR of 4.0 is elevated, and this patient could suffer a devastating bleed anywhere in the body. A patient with an INR < 5 without bleeding may have warfarin stopped temporarily. The maintenance dose should be decreased when it is safe to resume warfarin, i.e. when the INR is closer to the patient's therapeutic range. If the patient were at high risk for bleeding, was bleeding, or if the INR was greater than 4.0, vitamin K could be administered. A good history should be completed to find out the reason for the increase in INR. A high-risk client with an elevated INR would be admitted to the hospital and closely monitored, but a client with no

C.

Metoprolol is a cardioselective beta blocker. It can produce bradycardia which is responsible for exercise intolerance. As a patient exercises, a concomitant increase in heart rate allows for an

increase in cardiac output. If the heart rate is not able to increase because of beta-blocker influence, neither can the cardiac output. The patient will necessarily slow down his physical activity. Choices a and d have no direct effect on heart rate. Amlodipine is a calcium channel blocker that does not decrease heart rate. A 50-year-old patient with hypertension has taken hydrochlorothiazide 25 mg daily for the past 4 weeks. How should the nurse practitioner proceed (VS in image)? Wait 4 weeks before making a dosage change. Increase the hydrochlorothiazide to 50 mg daily. Add a drug from another class to the daily 25 mg hydrochlorothiazide. Correct Stop the hydrochlorothiazide and start a drug from a different class. C. The recommended target blood pressure, according to JNC 8, for this 50- year-old patient is < 140/ 90 mmHg. The current plan has not allowed this patient to meet this goal, so it is not acceptable to continue the current dose. Increasing the hydrochlorothiazide to 50 mg daily will not result in a decrease in blood pressure, only an increase in potassium loss. Adding a drug from a different medication class is a good choice because the combined effects of antihypertensive medications nearly always produce a decrease in blood pressure and both drugs can be maintained in low doses to minimize side effects. Which laboratory abnormality may be observed in a patient who takes lisinopril? Decreased INR Decreased calcium level Increased potassium level Increased ALT/AST C. Lisinopril is an ACE inhibitor. This medication causes retention of potassium. A potassium level should be measured about 1 month after initiating therapy and after each dose change. The other laboratory values are not specific to changes that can take place when a patient takes an ACE inhibitor.

Which class of medication is frequently used to improve long-term outcomes in patients with systolic dysfunction? Loop diuretics Calcium channel blockers ACE inhibitors Thiazide diuretics C. ACE inhibitors are commonly used in patients with systolic dysfunction because they reduce morbidity and mortality, i.e. these medications alter prognosis. They also improve symptoms of fatigue, shortness of breath, and exercise intolerance. Loop and thiazide diuretics improve symptoms, but do not alter long-term prognosis with heart failure. Beta blockers should be used in conjunction with ACE inhibitors and diuretics, but not as solo agents. Beta blockers can potentially worsen heart failure, so their use in patients with heart failure should be monitored carefully. Despite this fact, beta blockers decrease morbidity and mortality associated with heart failure. A patient will be screened for hyperlipidemia via a serum specimen. He should be told: to fast for 12-14 hours. to fast for 6-8 hours. that black coffee is allowed. a non-fasting state will not affect the results. A. Serum total and HDL cholesterol can be measured in fasting or non-fasting patients. There are very small and clinically insignificant differences in these values whether fasting or not. The primary effect of eating on a patient's lipid values is elevation of the triglyceride levels. The maximum elevation of triglyceride levels occurs at 3-4 hours after eating, but there may be several peaks during a 12-hour period. Therefore, the most accurate triglyceride levels will be obtained following a 12-hour fast. Ramipril has been initiated at a low dose in a patient with heart failure. What is most important to monitor in about 1 week? Heart rate Blood pressure EKG Potassium level D. ACE inhibitors work in the kidney in the renin-angiotensin aldosterone system and can impair

renal excretion of potassium in patients who have normal kidney function. In patients who have impaired renal blood flow and/or function, the risk of hyperkalemia is increased. Common practice is to monitor potassium, BUN, and Cr at about 1 week after initiation of an ACE inhibitor and with each increase in dosage in a patient who has heart failure and who receives an ACE inhibitor. A nurse practitioner has not increased the dosage of an antihypertensive medication even though the patient's blood pressure has remained >140/ mmHg. This might be described as: clinical inertia. malpractice . resistant hypertension. lackadaisical attitude. A. Clinical inertia is the term used to describe healthcare providers who fail to intensify therapy despite patients not reaching goal. There are many reasons given as to why this takes place, but healthcare providers can modify these behaviors. Warfarin treatment is greatly influenced by a patient's food and medication intake. Which group listed can potentially decrease INR (International Normalized Ratio) in an outpatient who takes warfarin? Alcohol and an aspirin Flu vaccine and ketoprofen Naproxen and celecoxib Sucralfate and cholestyramine D. The drugs listed in choice D will decrease international normalized ratio (INR) in patients who take warfarin concurrently. Sucralfate and calcium carbonate decrease absorption of warfarin. The drugs listed in the other choices will increase INR. Major interactions can occur with celecoxib, ketoprofen, and naproxen. These three NSAIDs are commonly taken by older adults, so this should be part of education with a patient who takes warfarin.

degeneration of the mitral tissue. The posterior leaflet is more commonly affected than the anterior leaflet. The valve's annulus becomes enlarged in conjunction with elongation of the chordae tendineae.

An older adult who has hypertension also has osteoporosis. Which antihypertensive agent would have the secondary effect of improving her osteoporosis? A thiazide diuretic A calcium channel blocker An ACE inhibitor A beta blocker A. Thiazide diuretics have the secondary effect of increasing serum calcium by decreasing fluid. This makes more calcium available for absorption. This would not be used to treat a patient with osteoporosis, but this mechanism of action could be helpful as an adjunct for patients who are receiving other forms of treatment for osteoporosis. The other agents listed would have no effect on osteoporosis. Calcium channel blockers impede movement of calcium into cells. This has no effect on available serum calcium. An independent 82-year-old male patient is very active but retired last year. His total cholesterol and LDLs are moderately elevated. How should the NP approach his lipid elevation? He has reached an age where treatment holds little benefit Treatment is age dependent; he should receive a statin today Treatment is based on expected length of life He should receive a statin today until he is 85 years C. Older adults have higher rates of coronary events than younger adults. Treatment of elevated lipids in older adults has been shown to decrease overall mortality, decrease major coronary events, and is associated with relative risk reduction for subsequent coronary events. United States Preventive Services Task Force and American Heart Association recommend lipid- lowering therapy because it clearly benefits older adults. This patient should have a statin started if lifestyle modifications do not allow him to reach goal lipid values. Tables are used for the determination of maximum blood pressure values for adolescents. How are these blood pressure values established for adolescents? Height percentile, body mass index, and gender Gender and age Height percentile, gender, and age Body mass index and gender C. Body size is an important determinant of blood pressure in adolescents. Blood pressure tables are NOT based on body mass index. The tables include 50th, 90th, 95th, and 99th percentiles based on age (up to 17 years), height, and gender. After age 17 years, all blood pressures are based on adult