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1. On your schedule for today is a 51-year-old African American male patient diagnosed three months ago with hypertension. The patient was started on chlorthalidone 25mg and educated on the DASH diet. At his one month follow up his chlorthalidone was increased to 50mg a day. He is I for his three month follow up. His BP today is 162/108. You review his home BP log and find todays reading aligns with most of the readings he documented from home monitoring. Witch the following is the most appropriate addition to his treatment plan?
A. Add Ramipril 2.5 mg
b. Change from Chlorthalidone to HCTZ
c. Add Carvedilol 12.5 mg
d. Add 5 mg of amlodipine
2. You have calculated the 10-Year risk of cardiac disease and stroke for your Type2 diabetic patient and find their values place in the pharmacologic treatment benefit range. The patient is averse to taking a statin but agrees to a trial of niacin. Patient education needs to include which of the following instructions?
a. Avoid Prolonged Sun exposure.
b. Decrease daily fluid intake
c. Reduce frequency of blood glucose monitoring.
d. Monitor for signs of orthostatic hypotension.
3. A 77-year-old patient with a history of hypertension comes in newly diagnosed with heart failure. Understanding the treatment guidelines for heart failure which of the following would you anticipate the patient to have been initially prescribed for NYHA class I/AHA stage A heart failure?
A. Diuretic
B. Calcium Channel Blocker
C. ACE inhibitor
D. Beta Blocker
4. You are seeing an 88-year-old female patient in follow up for her long-standing hypertension. Her hypertension. Her hypertension is well managed on 80 mg of Diovan (valsartan) for several years. Understanding the mechanism of action of the ARBs you know it works to lower blood pressure by which of the following?
a. Facilitates the release of aldosterone
b. Inhibits calcium influx into smooth muscle
c. Enhances prostaglandin synthesis
d. Blocks the action of angiotensin II
5. Ms. Y is a 74-year-old African American female in for her annual health evaluation. She denies any health problems or concerns. She is not on any routine medications and reports to taking melatonin 5mg occasionally at night to sleep. Her BP on intake for the visit is 147/88. Based on the JNC 8 guidelines which of the following interventions should be included in the treatment plan for her?
o Prescribe 12.5 mg chlorthalidone daily
o Prescribe 5 mg amlodipine daily
o Prescribe no medication
o Prescribe 10mg lisinopril daily
6. One of your office colleagues’ patients is on your schedule today. When asking for a same day appointment reported to the front office staff, they were feeling extremely fatigued and noted that their urine was “very dark”. Upon interviewing the patient, you learn that for the last 6 weeks the patient has been on lovastatin (Mevacor) 80 mg a day with dinner due to his last lipid panel with a total cholesterol level of 329.The patient denies any muscle pain or stiffness. You have the patient give you a urine specimen and inspection reveal it looks like “cola cola”. The treatment plan for today’s visit includes ordering labs and deciding on how to manage the Mevacor. Which of the following is most appropriate for today’s treatment plan?
a. Order a liver panel, a CK level, a lipid panel with no change in Mevacor.
b. Order a liver panel, a CK level, a lipid panel and half the Mevacor dose
c. Order a liver panel, a CK level, a lipid panel and dose of Mevacor every other day
d. Order a liver panel, a CK level, a lipid panel and discontinue the Mevacor
7. You are evaluating lipid panel results of a 44-year-old male. Results are as follow: total cholesterol of 256, HDL 32, LDL 159, and triglycerides 95. Based on these findings which of the following should you do?
o Refer him to a cardiologist
o Recommend regular aerobic activity
o Calculate 10-year risk of heart disease/stroke
o Prescribe a low dose statin
8. Two weeks ago, you diagnosed a 39-year-old nonsmoking patient with hypertension. The patient returns to the office today with a complaint of a dry cough within a week of starting on the BP medication. With knowledge of the side effects of hypertensive medications the advanced practice nurse suspects the new onset cough is likely a side effect of which of the following?
a. Thiazide Diuretic
b. ACE inhibitor
c. Beta Blocker
d. Calcium channel blocker
9. You have a patient who is under the care of their cardiologist for atrial fibrillation. The patient’s current management regimen includes amiodarone. Which of the following is not an adverse event associated with the amiodarone?
A. Tachycardia
B. Blue-gray skin
C. Hypothyroidism
D. Pulmonary fibrosis
10. 71-year-old patient comes in asking if they needed to be treated for their high blood pressure. Her current medications include citalopram 20 mg daily for depression. Were you to do due diligence in evaluating the patients’ blood pressure readings and determine that treatment is appropriate, which of the following medication classes should be avoided in this patient?
A. ACE inhibitors
b. Calcium channel blockers
c. Beta Blockers
d. Angiotensin receptor blockers
11. Your type 2 diabetic patient with co morbid hypertension comes in for a follow up related to hypertension management. They report home BP monitoring readings in the range of 140s- 150s systolic and 90s diastolic. In the office today the patients BP is 151/94. Based on the JNC 8 guidelines you know that for optimum management of this patient’s hypertension the BP needs to be in which of the following ranges?
12. Your 51-year-old female patient has just been diagnosed with stage II hypertension. She has a history of migraine headaches. As a part of your evaluation today you get an EKG and a CXR. Her CXR is negative, and her EKG shows a second-degree heart block. With this patient’s health history and today’s findings which of the following antihypertensive agents is best avoided for this patient?
a. Angiotensin receptor blockers
b. Calcium channel blockers
c. ACE inhibitors
d. Diuretics
13. Which of the following is an appropriate blood pressure for a 65-year-old male with no co-morbidities?
o SBC <135, DBP <85 o SBC <130, DBP ><80 o SBC ><150, DBP ><90 o SBC ><140, DBP ><130, DBP <80 o SBC <130, DBP ><80 o SBC ><150, DBP ><90 o SBC ><140, DBP ><150, DBP <90 o SBC <130, DBP ><80 o SBC ><150, DBP ><90 o SBC ><140, DBP ><140, DBP <90 15. Your 68-year-old patient with COPD and HF comes in for a visit prompted by his wife who says, "he does not want to eat and is just not feeling good". Current medications include Lasix (furosemide) 20 mg daily, Calan SR (verapamil hydrochloride) 180 mg daily, Digoxin 0.25 mg daily, symbicort 160/4.5(budesonide/formoterol) 2 inhales BID, and Theolair SR 200 mg (extended-release theophylline) BID. His BP is 162/98, Pulse 80, Respirations 22. You did 12 lead EKG and find he is in sinus rhythm with frequent premature atrial contractions. Which of the following interventions do you want to do next? a. Increase the patient's Calan SR dose. b. Refer the patient to a cardiologist c. Order digoxin, theophylline, and potassium levels d. Refer the patient to a Pulmonologist 16. You have just diagnosed a 67-year-old patient with type 2 diabetes. Which of the following drugs is recommended as the treatment of choice for treating hypertension in diabetic patients? o ACE inhibitor o Beta blocker o Diuretic o Calcium channel blocker 17. A long-standing patient comes in at 8:30am asking you to evaluate 'palpitations' that she has been having periodically. They usually occur at night and last only a few minutes. Since she was having them this morning, she decided to come in. On assessment you note an irregularly, irregular pulse with a rate in the 90s and her BP is 130/82. You suspect she is in atrial fibrillation and likely has been having intermittent episodes. You call her husband and ask him to transport her to a facility that can work her up appropriately. With your assessment that the patient has been experiencing intermittent episodes of atrial fibrillation which of the following regimens do you anticipate your patient will be on when you see her next? o Adenosine and heparin o Beta blocker and warfarin o ACE inhibitor and warfarin o Beta blocker and heparin 18. A patient comes to your office as a walk-in appointment with a complaint of a nagging 2- 3/10 chest pain for about the last 2 hours at work. He works in a manufacturing plant where he breaks down diesel part using a 20-pound sledgehammer. His coworkers noted his usual work rhythm was off and told him he needed to get checked out. He reports BP 100/56. You call an ACLS transport ambulance to take the patient to an emergency room. Which of the following pharmacologic interventions would you do while waiting for the ambulance to arrive? o Administer 20mg morphine IVP o Administer 75mg of Plavix (clopidogrel) o Administer 80mg of Lasix IVP o Administer 0.3mg nitroglycerin SL 19. A 45-year-old female is coming in today with a complaint of palpitations. She reports that for the last few weeks she has been plagued by sudden onset of feelings of palpitations that she also describes as 'feels like my heart is racing'. You ask if she has taken her pulse during any of these episodes and she says she didn't think about order an event monitor for the patient and find that episodes the patient is describing are periods where she is in PSVT (paroxysmal supraventricular tachycardia) addition to proceeding with a workup to evaluate the possible causes for PSVT in this patient, the advanced practice nurse would anticipate initiation of which of these? o Alprazolam (Xanax) 0.5mg PRN for anxiety o Verapamil hydrochloride (Calan SR) 180mg a day o Citalopram (Celexa) 20mg daily o Losartan (Cozaar) 50mg a day 20 You are seeing a patient with NYHA class III heart failure. Understanding pharmacologic management strategies which of the following agents would you not expect to see your patient on? a. Alpha blocker b. Hydralazine c. ACE inhibitor d. Diuretic

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