1. Patient A is a 48 year white male who comes to the emergency room complaining of chest pain and shortness of breath; he reports that while mowing the lawn he began having some chest tightness. After stopping to have a beer, instead of feeling better, he began feeling worse. He has a history of hypertension and diabetes which is diet controlled. He is currently taking: Toprol XL (metoprolol succinate) 50mg BID and
HCTZ (hydrochlorothiazide) 12.5 mg BID. His EKG is normal. He has had four troponin levels done, three of which were high. His blood pressure is 148/96, pulse 89, resp 26, shallow.
Which of the following is not a cardiac risk factor for Patient A a. Hypertension b. Diabetes c. Age/Gender d. Smoking
2. Patient A's blood pressure is: a. At goal for blood pressure treatment b. Better than the goal for blood pressure treatment c. Worse than the goal for blood pressure treatment.
3. Patient A tells you that he has a difficult time exercising, because he becomes fatigued to easily. The most likely reason for this is Patient A's: a. Metoprolol b. Hydrochlorothiazide c. Hypertension d. Diabetes
4. The lab value that most needs to monitored with patient A's medications is: a. Sodium b. Potassium c. Chloride d. Calcium
5. The most likely reason he has exercise intolerance is: a. His blood pressure is too low b. He has no discipline c. His potassium is too low d. His heart rate cannot increase enough.
6. You know that you will not give Patient A metoprolol if his: a. SBP > 180 mmHg b. SBP < 140 mmHg c. HR > 100 bpm d. HR < 60 bpm

7. You know that patient A's hydrochlorthiazide works by: a. Inhibiting sodium reabsorption in the loop of Henle b. Inhibiting sodium reabsorption in the distal convoluted tubule.
c. Inhibiting renin secretion by inhibiting renal beta-1 receptors d. Suppressing sodium-potassium pumps in the collecting ducts
8. Patient A tells you that he often has to get up in the middle of the night to go to the bathroom: You tell him: a. To stop taking his HCTZ b. To ask the physician to change HCTZ to Lasix (furosemide) c. To take the second dose of HCTZ before 1600 hours d. To stop drinking water after 1900 hours.
9. Patient A went to the cardiac cath lab and received an angioplasty and stent. He is now being transferred to your floor. He is stable on 2 liters of oygen nasal cannula and has an I.V. drip.
Which of the following drugs was most likely given IV to prevent the stent from clotting: a. Integrilin (eptifibatide) b. Lovenox (enoxeparin) c. Plavix (clopidogrel) d. Aggrenox (aspirin/dipyridamole)
10. Patient A went to the cardiac cath lab and received an angioplasty and stent. He is now being transferred to your floor. He is stable on 2 liters of oygen nasal cannula and has an I.V. drip.
The most likely short-term consequence of the drug given in the last question is: a. Petechiae b. Bleeding from the catheter insertion site c. Tachycardia d. Nausea
Answer: _____
11. According to Patient A's presentation and lab work, the most likely cause for his chest pain is: a. Arterial bleeding b. Cardiac hypoxia c. Muscle strain d. Functional hypoxia due to anemia
12. Which assesssment would best allow us to know whether Patient A is having a myocardial infarction?
a. Heart rate b. Temperature c. Troponin

d. EKG
13. Which statement reflects the reason why troponin levels would tell us anything clinically is that when cells are damaged: a. The contents spill out of the cells and into the blood.
b. Macrophages take the antigens and display them in the blood.
c. Taking a biopsy and observing it under a microscope allows us to tell the pathology.
d. Cells secrete troponin to signal the heart to beat faster.
14. The priority medication to give patient A is: a. ASA 325mg PO b. Plavix (clopidogrel) 75 mg PO c. Morphine 2 mg IV d. Naproxen 500 mg PO
15. Other than aspirin, the emergency treatment of Patient A should include (check all that apply) a. Amlodidpine b. Nitrates c. Adenosine d. Oxygen e. Acetaminophen f. Meperidine (Demerol) g. Morphine
16. Because Patient A has ruled in for MI, in addition to his current medications, the emergency treatment medications, what other medications are considered the standard of care for Patient A? (Check all that apply) a. Lisinopril b. Amlodipine c. Cholestyramine d. Atorvastatin e. Furosemide f. Terazosin
17. ACE inhibitors are part of the standard of care for MI patients because they: (check all that apply) a. Inhibit cardiovascular smooth muscle cell proliferation b. Increase development of coronary collateral circulation c. Decrease preload by inhibiting aldosterone d. Decreasing afterload by causing vasodilation e. Reduce myocardial oxygen demand by reducing heart rate.
18. You know that patient A's metoprolol is already helping to protect his heart from hi MI by: a. Inhibiting renal absorption of sodium b. Inhibiting cardiac remodeling secondary to aldosterone c. Enhancing the action of ANP (atrial natriuretic peptide) d. Reducing myocardial oxygen demand

19. During a myocardial infarction, the body's normal response to decreased cardiac output is: a. Appropriate b. Harmful because it causes increased oxygen demand in the heart
20. The body's normal response to decreased cardiac output is (check all that apply): a. Release of epinephrine b. Parasympathetic stimulation c. Increased urine output d. Activation of the RAAS e. Decreased cortisol release
21. With acute myocardial infarction oxygen is used: a. As a placebo to make patients feel better b. As a bronchodilator to allow more air exchange in the lung c. To Increase the partial pressure of oxygen allowing more to be absorbed by the alveoli.
d. To a dilate coronary arteries
22. You know that within 24 hours of an MI, the most likely thing to kill Patient A is: a. A second, larger MI so he should be anticoagulated b. Pulmonary embolism, so he should be anticoagulated c. Dysrhythmia so his ECG should be monitored continuously d. Stroke, so neuro checks should be done every hour
23. Patient A's sodium level is 138 and potassium is 3.7. Patient A's IV fluid is most likely: a. 0.9% NaCl b. 0.45% NaCl with 20 mEq of KCl c. D10W and insulin d. 0.9% NaCl and Calcium gluconate
24. Patient A tells you that since starting the blood pressure medication he has had difficulty obtaining an erection. You tell him: a. This is a warning sign, and you should immediately stop taking the medication.
b. This is common, because erections are caused by blood pooling in the penis, but that over time, as his blood pressure normalizes, his erections should normalize.
c. This is common, permanent, and irreversible.
d. This is uncommon, but the patient can just order some Viagra online.
25. Patient A tells you that he does not feel as stressed out while taking his blood pressure medications. You tell him that a. Hydrochorothiazide inhibits vasopressin (ADH) which causes relaxation.
b. Metoprolol enhances parasympathetic functioning by upregulating the vagus nerve.

c. Metoprolol prevents catecholamines from causing tachycardia preventing him from perceiving the physiological effects of anxiety.
d. Aspirin works as an anxiolytic.
26. Patient B is a 68 year old black male recovering from a left total knee replacement. He also has a history of hypertension, osteoarthritis in both knees, and coronary artery disease. He is currently on Lovenox
(enoxaparin) 0.7mg/0.7ml SC BID, ASA 81 mg PO daily, Zestoretic (lisinopril/HCTZ) 20/12.5 mg PO QD,
Percocet (oxycodone/acetaminophen) 5/325 mg PO Q6 hours PRN, Darvocet-N-100
(propoxyphene/acetaminophen) 100/650 mg PO Q6 hours PRN, Acetaminophen 500 mg 1-2 tabs Q6 hours
PRN.
Patient B tells you that he is in pain; 4/5. You have already given him 2 Acetaminophen with only a small amount of relief. You tell him that next time you will: a. Try acetaminophen again.
b. Use the percocet c. Use the Darvocet
27. Darvocet is: a. Appropriate for this patient because propxyphene is a weak opioid so it will not cause too many side effects b. Appropriate for this patient because the acetaminophen is very effective.
c. Inappropriate for this patient because the acetaminophen dose is too high.
d. Inappropriate for this patient because propoxyphene causes many side effects in elderly patients, with little analgesic effect.
28. Which of the following statements is definitely
regarding Patient B and NSAIDS?
a. Patient B is on an NSAID at a therapeutic dose for arthritits b. Patient B is on Acetaminophen instead because it has fewer side effects c. Patient B is not on an NSAID because it could potentiate GI bleeding in combination with aspirin
29. Patient B is taking Lovenox to: a. Prevent myocardial infarction b. Prevent stroke c. Prevent DVT and pulmonary embolism d. Prevent atherogenesis
30. Patient B is a 68 year old black male recovering from a left total knee replacement. He also has a history of hypertension, osteoarthritis in both knees, and coronary artery disease. He is currently on Lovenox
(enoxaparin) 0.7mg/0.7ml SC BID, ASA 81 mg PO daily, Zestoretic (lisinopril/HCTZ) 20/12.5 mg PO QD,
Percocet (oxycodone/acetaminophen) 5/325 mg PO Q6 hours PRN, Darvocet-N-100
(propoxyphene/acetaminophen) 100/650 mg PO Q6 hours PRN, Acetaminophen 500 mg 1-2 tabs Q6 hours
PRN.
Patient B is at increased risk for DVT because: (check all that apply) a. He is black b. He smokes c. He has reduced mobility

d. He take oral contraceptives e. Has had bone surgery that disrupts the marrow
31. The patient is on aspirin for: a. Treatment of degenerative arthritis b. Prevention of Myocardial infarction c. Prevention of colon cancer d. Prevention of DVT
32. Patient B's postassium will likely be: a. Normal because lisinopril raises potassium and HCTZ lowers potassium b. Normal because lisonpril lowers potassium and HCTZ raises potassium c. Low because both lisinopril and HCTZ lower potassium d. High because both lisinorpil and HCTZ raise potassium
33. Which of the following is NOT true of lisinopril?
a. It blocks the production of ACE b. It blocks breakdown of bradykinins c. It blocks the production of Angiotensin II d. It blocks the secretion of Aldosterone
34. The combination of lisinopril and HCTZ is: a. Is a poor choice because the two medications antagonize each other's actions b. Is a poor choice because the two medications do completely different things.
c. A good choice because both medications attack different aspects of hypertension pathophysiology.
d. Is a good choice because HCTZ by itself is ineffective.
35. What is the most likely reason why a patient would need to discontinue the lisinopril?
a. Orthostatic hypotension b. Hypokalemia c. Angioedema d. Cough
36. Patient D is a 35 year old white male who presents to the emergency room with complaints or itching and swelling lips. He has no known allergies. He has a history of hypertension and has been taking Lotrel
(Amlodipine/Benazepril) 5/20mg for three years. His blood pressure is 126/84, pulse is 63, resp 18, temp 98.3
Patient D's presentation is called: a. Hives b. Urticaria c. Angioedema d. Dermatitis

37. Patient D's swelling lips are most likely caused by: a. Complement activation b. Antibodies against collagen in his lips c. Inappropriate T cell reaction d. Excess histamine release
38. Patient D's reaction would be classified as: a. Type I Anaphylactic b. Type II Cytotoxic c. Type III Immune Complex d. Type IV Cell Mediated
39. From his history, which of the following is the most likely trigger for patient D's reaction?
a. Amlodipine b. Benazepril c. Shellfish d. Peanuts
40. The pathophysiology behind the trigger is: a. Inhibition of calcium channels in arteries causing edema b. Inhibition of beta-1 receptors c. Ingestion of food antigen d. Build-up of bradykinin in tissues.
41. If Patient D needs to change medications, his pulse rate would prevent him from taking which of the following medications: a. HCTZ b. Ramipril c. Propanolol d. Furosemide
42. If patient D needs to have epinephrine to treat his reaction, then a. His current medication will potentiate the epinephrine b. His current medications will have no effect on the epinephrine c. His current medications will inhibit the effect of the epinephrine
43. Patient E is a 64 year old black female presenting with lightheadedness; she has a history of MI and HTN.
She is taking Tarka (verapamil/trandolapril) 180/4 mg PO BID, HCTZ 12.5 mg PO daily. Her blood pressure

is 134/86, pulse 52, resp 16, temp 98.6.
Patient E's light headedness is most likely due to: a. Her blood pressure b. Respiratory rate c. Temperature d. Pulse rate
Answer: _____
44. Patient E’s heart rate is most likely due to a. Verapamil b. Trandolapril c. HCTZ
Answer: _____
45. Verapamil is different from amlodipine because verapamil: a. Affects the heart at therapeutic doses b. Enters the CNS more readily c. Does not affect arterial receptors d. Causes diuresis
Answer: _____
46. Which of the following is NOT true concerning verapamil: a. Verapamil is dromotropic b. Verapamil is inotropic c. Verapamil is chronotropic d. Verapamil is cholinergic
Answer: _____
47. Which of the following is not a reason why Tarka is better than taking verapamil and trandolapril as separate pills.
a. The combination tablet potentiates the action of the two medications b. The combination tablet only causes one co-pay with insurance c. The combination tablet enhances compliance because fewer pills are needed.
d. The combination tablet reduces the number of medications for the patient to confuse.
Answer: _____
48. Patient E complains of constipation. This is most likely due to:

a. Her lightheadedness b. Verapamil c. Trandolapril d. HCTZ
49. While examining patient E, you notice that she coughs quite often. She tells you that it is persistent and dry.
The most likely cause is Patient E's: a. Allergies b. Verapamil c. Trandolapril d. HCTZ
50. To relieve patient E's lightheadedness, the physician is likely to: a. Increase the verapamil component of Tarka b. Increase the HCTZ c. Decrease the HCTZ d. Decrease the verapamil component of Tarka
Answer: _____
51. The physician discontinues verapamil altogether, but Patient E's heart rate continues to stay low. What is her most likely treatment?
a. Epinephrine b. Adenosine c. Heart transplant d. Pacemaker
52. Before discharging Patient E, you discuss the flu vaccine with Patient D. You tell her: a. Flu vaccines are usually ineffective.
b. Flu vaccines are only recommended for the elderly, so she does not need one.
c. Patient D should wait until the first case of Swine Flu occurs in the U.S. before getting one.
d. The flu vaccines is recommended for Patient D
53. The definition of heart failure is: a. back up of blood in the feet or lungs causing edema b. cardiac arrest c. failure of the heart to meet the body's demand for oxygen.

54. Patient F is admitted to your floor with a moderate exacerbation of Chronic Heart Failure. Before admission, the patient was on carvedilol (Coreg) 6.25mg BID, ASA 81 mg daily, Lisinopril 30mg PO daily, and
Digoxin 0.125 mg PO daily.
Which of the following symptoms/signs would you expect to find in Patient F?
a. Tachypnea b. Bradypnea c. Wheezes d. Crackles e. Pedal edema f. Periorbital edema g. Sudden weight loss h. Sudden weight gain
55. Patient F's weight on admission is 168 lbs. He tells you that he usually weighs 152. You know that a. Patient F must have eaten a lot in the past few weeks.
b. Patient F must have retained ~7 liters of water.
c. Patient F must have retained ~16 liters of water.
d. Patient F must have a severe case of constipation.
56. Which of the following lab values would be used to confirm a diagnosis of heart failure exacerbation?
a. Increased BNP levels b. Increased Creatinine levels c. Increased Blood Pressure d. Increased Calcium e. Increased Albumin
57. The foundation of Patient F's acute treatment plan on a general medical floor will be: a. Inotropic support b. Vasodilation c. Diuresis
58. The foundation of Patient F's acute treatment plan in an intensive care unit will be: a. Inotropic support b. Vasodilation c. Diuresis
59. The rationale for Patient F's diuresis is that decreasing fluid (check all that apply): a. reduces pulmonary edema b. activates epinephrine release causing increased force of contraction c. reduces overstretching of the heart, causing increased force of contraction d. is crazy, because increased preload increases contractility
60. Immediately before giving the patient digoxin you

a. Check her blood pressure b. Check her respirations c. Check her heart rate d. Assess for edema
61. Patient F's lab results come back:
Electrolytes
a. Patient F is at increased risk for digoxin toxicity b. Patient F is at decreased risk for digoxin toxicity c. Patient F is at normal risk for digoxin toxicity
62. Given Patient F's labs, what other disease does Patient F likely have?
a. Systemic Lupus Erythematosus b. Pneumonia c. Pumonary embolism d. Diabetes mellitus?
63. The physician checks Patient F's Blood Gases. What does Patient F have?
pH 7.46
PaCO2 28
HCO3- 18 a. Overall acidosis b. Overall alkalosis c. Overall normal pH
64. The physician checks Patient F's Blood Gases. What does Patient F have? pH 7.46
PaCO2 28
HCO3- 18 a. Respiratory alkalosis b. Respiratory acidosis c. Normal respiratory function
65. The physician checks Patient F's Blood Gases. What does Patient F have? pH 7.46

PaCO2 28
HCO3- 18 a. Primary respiratory alkalosis with compensatory metabolic acidosis b. Primary respiratory acidosis with compensatory metabolic alkalosis c. Primary metabolic alkalosis with compensatory respiratory acidosis d. Primary metabolic acidosis with compensatory respiratory alkalosis
66. The physician checks Patient F's Blood Gases. What is most likely causing Patient F's pH? pH 7.46
PaCO2 28
HCO3- 18 a. Tachypnea secondary to heart failure b. Tachypnea secondary to anxiety c. Asthma d. Ketoacidosis
67. Which of the following medications is contraindicated or should only be used with extreme caution for patient F? (check all that apply) a. Metformin (Glucophage) b. Insulin c. Pioglitazone (Actos) d. Glimepiride (Amaryl)
68. Which medication is likely to be added to Patient F's regimen to help manage her heart failure on an outpatient basis?
a. Naseritide (Natrecor) b. Spirionolactone (Aldactone) c. Dopamine d. Nitroglycerine
69. Patient G is a 56 year old white male who comes into the Emergency Room with chest pain and shortness of breath for three days. He has crackles in both lungs bilaterally. He has no history of hypertension, hyperlipidemia, does not smoke. His ECG shows an irregular rhythm with no P waves. His first two sets of cardiac enzymes are negative. His chest pain is not relieved by sublingual nitroglycerine. His BP is 112/68,
Pulse 112 bpm, Resp 26.
What is meant by Cardiac enzymes in today's practice? (Choose all that apply) a. Lactic acid b. LDH c. CK d. CK-MB e. Troponin I or T f. Troponin H

70. In order for patient G to be ruled out for MI he will need a. He already is ruled out b. Two more sets of negative enzymes c. Three more sets of negative enzymes d. Four more sets of negative enzymes
71. Patient G's ECG is most indicative of a. Atrial Flutter b. Atrial Fibrillation c. Premature atrial contraction d. Premature ventricular contraction e. Ventricular tacyardia f. Ventricular fibrillation g. First degree heart block h. Second degree heart block i. Third degree heart block j. WPW
72. Patient G's chest pain is considered a. Stable angina b. Unstable angina c. Prinzmetal angina
73. Patient G is admitted to the cardiac unit with acute heart failure. The most likely cause of his heart failure is: a. Increased preload due to kidney failure b. Increase preload due to valvular malfunction c. Decreased preload due to dehydration d. Decreased preload due to loss of atrial kick
74. When a patient has acute heart failure, the nurse should carefully monitor the patient's labs for signs of a. Liver failure b. Kidney failure c. Stroke d. Anemia
75. When monitoring for signs of Acute Renal Failure in an acute heart failure patient, the nurse should pay particular attention to which of the following labs?
a. Potassium b. Sodium c. Chloride d. Glucose

76. Patient G is told that he needs to be cardioverted. What diagnostic test will be administered before cardioversion?
a. Thallium test b. Coronary angiogram c. Stress echo d. Transesophageal echocardiogram (TEE)
77. If Patient G's TEE comes back positive, it means: a. The patient is cleared to be cardioverted b. A pumonary embolism has been detected, and the patient needs oxygen and heparin c. A pumonary embolism has been detected, and the patient needs oxygen and warfarin d. Atrial thrombi have been detected, and the patient needs aspirin e. Atrial thrombi have been detected, and the patient needs heparin
78. Patient G's second TEE is negative, and the patient undergoes cardioversion. If it does not work, which two medications is Patient G most likely to be discharged on?
a. Warfarin b. Heparin c. Clopidogrel (Plavix) d. Lidocaine e. Amiodarone f. Amlodipine g. Adenosine
79. Which of the following would be considered a sign of decreased perfusion?
a. Alert and oriented x4 b. Capillary refill 2 seconds c. Pedal Pulses +2 bilaterally d. UOP of 300mL in a 12 hour shift
80. Clopidogrel (Plavix) works by: a. Inhibiting the intrinsic pathway by inhibiting Factor Xa synthesis.
b. Inhibiting the intrinsic pathway by directly inactivating Factor Xa.
c. Inhibiting platelets by inhibiting ADP receptors d. Inhibiting platelets by inhibiting platelet cyclo-oxygenase
81. What is the following ECG rhythm?

a. Normal Sinus Rhythm b. Atrial Fibrillation c. Premature Ventricular Complex d. Ventricular Tachycardia e. Ventricular Fibrillation
82. What is the following rhythm? a. Normal Sinus Rhythm b. Atrial Fibrillation c. Premature Ventricular Complex d. Ventricular Tachycardia e. Ventricular Fibrillation
83. What is the following rhythm? a. Normal Sinus Rhythm b. Atrial Fibrillation c. Premature Ventricular Complex d. Ventricular Tachycardia e. Ventricular Fibrillation
84. What is the following rhythm? a. Normal Sinus Rhythm

b. Atrial Fibrillation c. Premature Ventricular Complex d. Ventricular Tachycardia e. Ventricular Fibrillation
85. What is the following rhythm? a. Normal Sinus Rhythm b. Atrial Fibrillation c. Premature Ventricular Complex d. Ventricular Tachycardia e. Ventricular Fibrillation