1.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? (Points : 0.4)
A 61-year-old man who has a heart valve infection and recurrent fever
An 81-year-old woman who has had an ischemic stroke and has consequent one-sided weakness
A 44-year-old man awaiting a kidney transplant who requires hemodialysis three times per week
A 66-year-old woman with poorly controlled angina and consequent limited activity tolerance
Question 2.2. 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? (Points : 0.4)
BNP is released as a compensatory mechanism during heart failure and measuring it can help differentiate the patient’s dyspnea from a respiratory pathology.
BNP is an indirect indicator of the effectiveness of the RAA system in compensating for heart failure.
BNP levels correlate with the patient’s risk of developing cognitive deficits secondary to heart failure and consequent brain hypoxia.
BNP becomes elevated in cases of cardiac asthma, Cheyne-Stokes respirations, and acute pulmonary edema, and measurement can gauge the severity of pulmonary effects.
Question 3.3.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? (Points : 0.4)
An increase in preload via the Frank-Starling mechanism
Sympathetic stimulation and increased serum levels of epinephrine and norepinephrine
Activation of the renin-angiotensin-aldosterone (RAA) system and secretion of brain natriuretic peptide (BNP)
AV node pacemaking activity and vagal nerve suppression
Increased preload due to vascular resistance
High afterload because of backpressure against the left ventricle
Impaired contractility due to aortic resistance
Systolic impairment because of arterial stenosis
Question 5.5.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?(Points : 0.4)
Aneurysms are commonly a result of poorly controlled diabetes mellitus.
Hypertension is a frequent modifiable contributor to aneurysms.
Individuals with an aneurysm are normally asymptomatic until the aneurysm ruptures.
Aneurysms can normally be resolved with lifestyle and diet modifications.