. Which of the following components of the pathologist’s report is most suggestive of a possible history of poorly controlled blood pressure?

• Question 1. A 72-year-old woman with a recent onset of syncopal episodes has been referred to a cardiology group by her family physician. As part of the patient’s diagnostic workup, the nurse practitioner conducting the intake assessment has ordered a Holter monitor for 24 hours. Which of the following statements best captures an aspect of Holter monitoring?
• Question 2. As part of the diagnostic workup for a male patient with a complex history of cardiovascular disease, the care team has identified the need for a record of the electrical activity of his heart, insight into the metabolism of his myocardium, and physical measurements, and imaging of his heart. Which of the following series of tests is most likely to provide the needed data for his diagnosis and care?
• Question 3. An 81-year-old female patient of a long-term care facility has a history of congestive heart failure. The nurse practitioner caring for the patient has positioned her sitting up at an angle in bed and is observing her jugular venous distention. Why is jugular venous distention a useful indicator for the assessment of the patient’s condition?
• Question 4. A physical assessment of a 28-year-old female patient indicates that her blood pressure in her legs is lower than that in her arms and that her brachial pulse is weaker in her left arm than in her right. In addition, her femoral pulses are weak bilaterally. Which of the following possibilities would her care provider be most likely to suspect?
• Question 5. A 6-year-old boy has been brought to the emergency department by ambulance after his mother discovered that his heart rate was “so fast I couldn’t even count it.” The child was determined to be in atrial flutter and his mother is seeking an explanation from the health care team. Which of the following points should underlie an explanation to the mother?
• Question 6. A 66-year-old patient’s echocardiogram reveals a hypertrophied left ventricle, normal chamber volume, and a normal ejection fraction from the heart. What is this patient’s most likely diagnosis?
• Question 7. A 70-year-old male patient presents to the emergency department complaining of pain in his calf that is exacerbated when he walks. His pedal and popliteal pulses are faintly palpable and his leg distal to the pain is noticeably reddened. What would his care provider’s preliminary diagnosis and anticipated treatment most likely be?
• Question 8. A patient in the intensive care unit has a blood pressure of 87/39 and has warm, flushed skin accompanying his sudden decline in level of consciousness. The patient also has arterial and venous dilation and a decrease in systemic vascular resistance. What is this patient’s most likely diagnosis?
• Question 9. A 31-year-old woman with a congenital heart defect reports episodes of lightheadedness and syncope, with occasional palpitations. A resting electrocardiogram reveals sinus bradycardia and she is suspected of having sick sinus syndrome. Which of the following diagnostic methods is the best choice to investigate the suspicion?
• Question 10. A nurse practitioner is providing care for several patients on a medical unit of a hospital. In which of the following patient situations would the nurse practitioner be most likely to rule out hypertension as a contributing factor?
• Question 11. A patient is experiencing impaired circulation secondary to increased systemic arterial pressure. Which of the following statements is the most relevant phenomenon?
• Question 12. A number of patients have presented to the emergency department in the last 24 hours with complaints that are preliminarily indicative of myocardial infarction. Which of the following patients is least likely to have an ST-segment myocardial infarction (STEMI)?
• Question 13. A formerly normotensive woman, pregnant for the first time, develops hypertension and headaches at 26 weeks’ gestation. Her blood pressure is 154/110 mm Hg and she has proteinuria. What other labs should be ordered for her?
• Question 14. An older adult female patient has presented with a new onset of shortness of breath, and the patient’s nurse practitioner has ordered measurement of her BNP levels along with other diagnostic tests. What is the most accurate rationale for the nurse practitioner’s choice of blood work?
• Question 15. The nurse practitioner for a cardiology practice is responsible for providing presurgical teaching for patients who are about to undergo a coronary artery bypass graft. Which of the following teaching points best conveys an aspect of the human circulatory system?
• Question 16. A 54-year-old man with a long-standing diagnosis of essential hypertension is meeting with his nurse practitioner. The patient’s nurse practitioner would anticipate that which of the following phenomena is most likely occurring?
• Question 17. A 22-year-old male is experiencing hypovolemic shock following a fight in which his carotid artery was cut with a broken bottle. What immediate treatments are likely to most benefit the man?
• Question 18. A 66-year-old obese man with a diagnosis of ischemic heart disease has been diagnosed with heart failure that his care team has characterized as attributable to systolic dysfunction. Which of the following assessment findings is inconsistent with his diagnosis?
• Question 19. A 68-year-old male complains to his nurse practitioner that when he tests his blood pressure using a machine at his pharmacy, his heart rate is nearly always very low. At other times, he feels that his heart is racing, and it also seems to pause at times. The man has also occasionally had lightheadedness and a recent syncopal episode. What is this patient’s most likely diagnosis and the phenomenon underlying it?
• Question 20. An autopsy is being performed on a 44-year-old female who died unexpectedly of heart failure. Which of the following components of the pathologist’s report is most suggestive of a possible history of poorly controlled blood pressure?
• Question 21. During a routine physical examination of a 66-year-old woman, her nurse practitioner notes a pulsating abdominal mass and refers the woman for further treatment. The nurse practitioner is explaining the diagnosis to the patient, who is unfamiliar with aneurysms. Which of the following aspects of the pathophysiology of aneurysms would underlie the explanation the nurse provides?
• Question 22. A patient has suffered damage to his pericardium following a motor vehicle accident. Which of the following consequences should the nurse practitioner be most likely to rule out?
• Question 23. A nurse practitioner is instructing a group of older adults about the risks associated with high cholesterol. Which of the following teaching points should the participants try to integrate into their lifestyle after the teaching session?
• Question 24. An 81-year-old male resident of a long-term care facility has a long-standing diagnosis of heart failure. Which of the following short-term and longer-term compensatory mechanisms is least likely to decrease the symptoms of his heart failure?
• Question 25. A 55-year-old male who is beginning to take a statin drug for his hypercholesterolemia is discussing cholesterol and its role in health and illness with his nurse practitioner. Which of the following aspects of hyperlipidemia would the nurse practitioner most likely take into account when teaching the patient?

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