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Med and surg Adult > Cardiac practice > Flashcards

Cardiac practice Flashcards

1
Q

A nurse is screening a pt for HTN. The nurse should identify that which of the following actions by the pt increases the risk for HTN? SATA
a. Drink 8 oz nonfat milk daily
b. Eating popcorn at the movie theater
c. Walking 1 mile daily at 12min/nile pace
d. Consuming 36 oz beer daily
e. Getting a massage once a week

A

b, d
More than 24oz(700ml) male and 12oz(360ml) feaml per day risk of HTN.

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2
Q

A nuse is an urgent care clinic is obtaining a history from a pt who has type 2 diabetes melltius and a recent diagnosis of HTN. This is the second time in 2 weeks that the pt experienced hypoglycemia. Which of the following pt data should the nurse report the provider?
a. Takes psyllum daily as a fiber laxative
b. Drinks skim milk daily as a bedtime snack
c. Take metoprolol daily after meals
d. Drinks grapfruits juice daily with breakfast

A

c
Metorolol can mask the effect of hypoglycemia.
Because B-blocker cause decrease HR.

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3
Q

hypoglycemia symptoms?
blood glucose level?

A

Fast heartbeat
Shaking
Sweating
Nervousness or anxiety
Confusion
Dizziness
Hunger
blood glucose levels fall below 70 mg/dL

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4
Q

hyperglycemia symptoms?
blood glucose level?

A

Increased thirst and a dry mouth
Frequent urination
Weakness
Blurred vision

Above 180 to 200 mg/dL

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5
Q

A nrsue is caring for pt who is admitted to the ED with BP 266/147.
The pt reports a headache and double vision. The pt states, “ I ran out of my diltiazem 3 days ago and I am unable to purchase more” Which of the following actions should the nruse take first?
a. Asminister acetaminophen for headache
b. Provide teaching reagrding the importance of not abruptly stopping an antihypertencive
c. Obtain IV access
and prepare to administer an IV anthihypertensive

A

c
The greatest risk to the t is injury d/t a BP of 266/147, which can be life-theratening and should be lowered as soon as possible.

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6
Q

A nurse is providing teacing for a pt who has new diagnosis of HTN and new prescription for spironolactone 25mg/day. Which of the following statements by the pt indicates an understanding of the teaching?
a. I should eat lot of fruits and veges, especially banannas and potetos.
b. I will report any changes in herat reate to my provider.
c. I should replace the salt shaker on my table with a salt substitite.
d. I will decrease the dose of this medication when I no longer have headache and facial redness.

A

b
hyperkalemia affect HR=irregular heartbeat
a. Banana and potetos are high in potassium

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7
Q

A nruse is admitting a pt who has suspected MI and a history of angina. Which of the followigng findings will help the nurse distinguish stable angina from an MI?
a. Stable angina can be relived with rest and nitroglycelin.
b. The paong of an MI resolves in less than 15 min,
c. The type of activity that causes an MI can be identified.
d. Stable angina can occur for longer than 30 min.

A

a

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8
Q

A nurse is reviewning the laboratory findings of a pt who has a diagnosisi of MI and reports that his dyspnea began 2 weeks ago. Which of the following cardiac enzymes would confirm the MI occured 14 dsys ago?
a. CK-MB
b. Troponin 1
c. Troponin T
d. Myoglobin

A

c
a. no longer after 3 days
b. no longer after 7-10 days
d. no longer agter 24hr

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9
Q

A nruse is caring for a pt who asks the provider prescribed a daily aspirin. Which of the following responsess should then nurse make?
a. Asprin reduces the formation of blood clots that could cause a heart attack.
b. Asprirn relives the pain due to myocardial ischemea.
c. Aspirin dissolves clots that aere forming in your cornary arteries.
d. Asprin relieves headaches that are cuased by onother medication.

A

a
Aspirin decrease platelet aggregation that can cause a MI.
-One aspilin per day is not sufficient to alleviate ischemia pain
-Aspirin dose not dissolve clots

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10
Q

A nurse is teaching a pt who has angina about a new prescription for metopolol. Which of the following statements by the pt indiates understanding of the teaching?
a. I should place the tablet nuder my tongue
b. I should have my clotting time checked weekly
c. I will report any ringing in my ears.
d. I will call my provider if my pulse rate is less than 60.

A

d
B-blocker can cause bradycardia

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11
Q

A nurse is presenting a community education program on recommended lifestyle changes to prevent angina and MI. Which of the following changes should the nurse recommend be made first?
a. Diet modification
b. Relacation excersice
c. Smoking cessation
d. Taking omega-3 capsules

A

c
Nicotine cause soconstriction,elavate BP and narrows cornary arteries.

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12
Q

Which BP-regulating mechanisums can result in the developent of HTN if defective?SATA
a. Release of norepinephrine
b. Secretion of prostaglands
c. Situmulation of the SNS
d. Situmulation of the PNS
e. Activation of the RAAS

A

a,c,e
a.ncreasing heart rate and constricting blood vessels, increasing renin secretion
c. vasoconstriction of most of the blood vessels

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13
Q

While obtaing subjective assessment data from a pt with HTN, th nurse recognize that a modifiable risk factor for the development of HTN is?
a, A low calcium diet
b. Excess alcohol intake
c. A family history of HTN
d. Consumption of a high-protein diet

A

b

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14
Q

In teaching a pt with HTN about controlling the illness, the nruse recognize that
a. All pt with elavated BP need drug thearpy
b. Obese preson must achieve a normal weight to lower BP
c. It is not necsary to limit salt in the diet if taking a diuretics
d. Lifestyle modifications are needed for all persons with elavated BP

A

d

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15
Q

A pt with newly discoverd high BP has an average reading of 158/98 after 3 months of exercise and diet modifications. Which manageent strategy will be a priority for this pt?
a. Drug therapy will be needed because the BP is still not at goal.
b. BP monitorning should continue for 3 months to confirm for a diagnosis of HTN.
c. Lifestyle changes are less important since they were not effective, and drug will be started.
d. More changes in the pt’s lifestyle are needed for a longer time before starting drug thearpy.

A

a

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16
Q

A pt is admitted to the hospital in a hypertensive emergency(BP 244/142). Sodium nitroprusside is started. which management strategies would be most appropreiate for this pt? SATA
a. Measuring hourly urine output
b. Continuous BP monitorung with an arterial line
c. Decreasing the MAP by 50% within the first hour
d. Maintaining bed rest and giving tranquilizwersand to lower the BP
e. Assesing the pt for S/S of HF and changes in mental status.

A

a,b,e
Sodium nitroprusside used for mnagement of acute hypertension

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17
Q

Which statements accurately describe HF with HFpEF?SATA
a. Uncontrolled HTN is the primary cause.
b. LV ejection fraction may be within normal limits.
c. The pathophysiology involves ventricular relaxation and filling
d. Multiple evidence based therapies have been shown to decrase mortality
e. Therapies focus on symptoms control and tratment of underlying condition.

A

a,b,c,e

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18
Q

What compensatory mechanisum involeved in both chronic HF and acute HF leads to fluid reterntion and edema?
a. Ventricular dilation
b. Ventricular hypertrophy
c. Increased systemic BP
d. Renin-andiotensin-aldosterone activation

A

d

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19
Q

The nurse is caring for a pt with acute HF who is receving IV dobutamine. Why would this drug be prescribe?
SATA
a. It dilates renal blood vessels
b. It will incraease the HR
c.Heart contractility will improve
d.Dobutamine is a selective b-agonist.
e. It increase systemic vascular resistance

A

c,d
dobutaminec is treats heart failure by strengthening your heart muscle.

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20
Q

A pt with chronic HF and atrial fibillation is treated with low-dose digitalis and loop diuretic, What does the nurse need to do prevent complications of this drug combinations? SATA
a. Monitor serum potassium levels
b. Teach the pt how to take a pulse rate
c. Keep an accurate measure of I&O
d. Teach the pt about dietary potassium restrictions.

A

a,b

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21
Q

A barrier to hospice referrals for pt with stage D HF is
a. family member refusal
b. scarcity of hospice facilities
c. history of pacemaker placment
d. difficulty in estmating prognosis

A

d/予後

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22
Q

Pt are at risk for which complications in the first year after heart transplantation? SATA
a. cancer
b. rejection
c. vasculopathy
d. sudden cardiac death

A

b,c,e

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23
Q

In teaching a pt about CAD, the nurse explains that the changes that occur in this disorder include? SATA
a. diffuse involvement of plaque formation in cornary veins
b. abnormal levels of cholesterol, especially LDL
c. accumlation of lipid and fibrous tissue within the cornary arteries
d. development of angina due to a decreased blood supply to the heart muscle
e. shronic vasoconstriction of cornary arteries leading to permanent vasospasum

A

b,c,d

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24
Q

After teaching about way to decrease risk factors for CAD,the nurse recognizes that further instruction is needed when the pt says
a. I can keep my blood pressure normal with medicatrion
b. I would like to add weight lifiting to my excrcise program
c. I can change my diet to decrease my intake of saturated fats
d. I will change my lifestyle to reduce activites that increase stress

A

b
can lead to an increased risk of heart attack or stroke in those who are already at risk.

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25
Q

A hospitalized pt with a history of chronic stable angina tells the nruse that she is having chest pain. The nurse bases his actions on the knowledge that ischemia
a. will always progress to myocardial infarction
b. can be relived by rest, nitroglycerin, or both
c. is often associated with vominting and extream fatigue
d. indicated that irreversible myocardial damage is occuring

A

b

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26
Q

The nruse is caring for a pt who is 2days post MI. The pt reports that she is experiencing chest pain when she takes a deep breath. which action would be a priority?
a. notify the provider STAT and abtain a 12 lead ECG
b. obtain vital sing and ausculate for a pericardial fricrtion rub
c. apply high flow O2 by face mask and ausculate breath sounds
d. medicate the pt with as-needed analgesic and reevaluate in 30 mins

A

b

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27
Q

A pt is admitted to the ICU with a diagnosis of NSTEMI.Which drugs would the nurese expect the pt to recieve? SATA
a. Oral statin
b. Antiplatelet
c. Thrombolytic
d. Prophylatic antibiotics
e. Intravenous nitroglycerin

A

a,b,e

28
Q

A pt is recovering from an uncomplicated MI. Which rehabilitation guideline is a priority to include in the teaching plan?
a. refrain from sexual activity for a minimum of 3 weeks
b. plan a diet program that aims for a 1-to 2lb weight loss per week
c. begin an exercise program that aims for at least 30 mints session per week
d. cosider the use of erectile agents and prophylatic NTG before engaging in sexual activity

A

c

29
Q

The most common findings in people at risk for sudden cardiac death is
a. aortic valve disease
b. mitral valve disease
c. left ventricular dysfunction
d. atherosclerotic heart disease

A

c

30
Q

A nurse is caring for a pt who has heart failure and reports increased shortness of breath. Which of the following actions should the nurse take first?
a. Obtain the pt’s weight
b. Assist the pt into high-fowler’s position
c. Asculate lungs sounds
d. Check oxygen saturation wigh pulse oximeter

A

b
Using the ABC, the first action to take is to assist the position. This will decrease venous return to the heart(preload) and help relieve lung congestion

31
Q

A nurse is teaching a pt who HF and new prescription for furosemide and digoxin. Which of the following infor should the nurse include? SATA
a. Weigh daily, firtst thing each morning
b. Decerawes intake pottasium
c. Expect muscle weakness while taking dioxin
d. Hold digoxin if HR is less than 70
e. Decrease sodiu intake

A

a,e
b. increase is correct
c. report muscle weakness is digoxin toxicity
d. Hold if 50 to 60

32
Q

A nurse is completing the admission assesment of a pt who has suspected pulmonary edema. Which of the following manifestations are expected findings? SATA
a. Tachypnea
b. Persistent cough
c. Increased urinary output
d. Thick, yellow sputum
e. Orthopnea

A

a,b,e
c. decrease is correct
d. Pink,frothy 泡の多いsputum

33
Q

A nrsue is talking with a pt who has class 1 HF and asks about obtaining a ventricular assist device(VAD). WHich of the following statement should the nurse make?
a. VAD are only implanted during heart transplantation
b. VAD helps to pace the heart
c. VADs are used when HF is not responsive to medications
d. VAD is useful for pt who also have a chronic lung issue

A

c

34
Q

A nruse is providing discharge for a pt who has HF and is on a fluid restriction od 2000mL/day. The pt asks the nurse how to determine the appropriate amount of fluid they are allowed. Which of the following statements is an appropriate response by the nurse?
a. Pour the amount of fluid you drink into an empty 2L bottole to keep track of how much you drink
b. Each glass contains 8 ounces. There are 30 mL oer onces, so you can have total 8 glasses
c. This is the same as 2 quater, or abot the same as tow pots of coffe
d. take sips if water or ice chips so you will not take in too much fluid

A

a

35
Q

A nurse is caring for a pt who has pericarditis.Which of the following findings should the nruse expect?
a. Petechiae
b. Murmue
c. Rash
d. Friction rub

A

d
a.
Tiny round brown-purple spots due to bleeding under the skin/endocarditis
b.myocarditis and endocarditis
c. rhematic endocarditis

36
Q

A nurse is caring for 4 pts.WHich of the following pt should the nruse identify as being at risk of developing rheumatic endocarditis?
a. Old adult who has chronic obstructive pulmonary disease
b. Child who has streptococcal pharyggitis
c. Middle-aged adult who has lupus erythematosus
d. Young adult who recently recived a body tatto

A

b
streptococcal pharyggitis is at risk of rheumatic fever, its developing rheumatic endocarditis
a,b,c they are not at risk unless they develop rheumatic fever

37
Q

A nurse is caring for a pt who has been on long term NSAID therapy to treat pericarditis. Which of the following lab findings shoyld the nurse reports to provider?
a. Platelets 100,000/mm
b. Serum glucose 110mg/dl
c. Serum creatinine 0.7mg/dl
d. Amino alanine transferase 30IU/L

A

a
NASID can lower platelate
Normal range 150,000 to 450,000/mm

38
Q

A nurse is assessing a pt who has splinter hemorrhages of the nail beds and reports a fever. The nurse should identify these findings as manifestations of which disorder?
a. Infective endocarditis
b. Pericarditids
c. Myocarditids
d. Rheumatic endocardidits

A

a
b. would report chest pain
c. Would report a rapid HR
d. would report joint pain

39
Q

A nrsue is admitting a pt who has suspected rhematic endocarditis.The nruse should expect a preswcription for which of the following lab tests to assist in confirmation of this disorder?
a. Arterial blood gases
b. Serum albumin
c. Liver enzymes
d. Throat cuulture

A

d
Throat culture can reveak the presence of steptococcus, which is the leading cause of rhematic endocardtits.

40
Q

Which s/s should the nurse expect to find when assesisng a pt wigh infective endocarditis who uses IV cocaine? SATA
a. REtinal hemorrhages
b. Spkinter hemorrhages
c. Presence of Osler’s nodes
d. Painless nodules over bony prominences
e. Erythematous macules on the palms and soles

A

a,b,c,e

41
Q

**Priority nursing management for a pt with myocarditis includes interventions related to **
a. meticulous skin care
b. antibiotic prophylaxis
c. tight glycemic control
d. oxygenation and ventilation

A

d

42
Q

When teaching a pt about the long-term consequences of rheumatic fever, the nurse should discuss the possibility of
a. valvilar heart disease
b. pulmonary hypertension
c. superior vena cava syndrome
d. hypertrophy of the rifht ventricle

A

a

43
Q

Which is a priority nursing intervention for a pt during the acute phase of rheumatic fever?
a.Giving IV antibiotics as prescribed
b. Managing pain with opioid analgesics
c. Encouraging fluid intake for hydration
d. performing frequent active range of motion exercise

A

a

44
Q

A pt is diagnosed with mitral stenosis and new onset atrial fibrillation. Which interventions could the nruse delegate to unlicensed assistive persinnel(UAP)? SATA
a. Obtain and record daily weight
b. Determine apical-rapidal pulse rate
c. Observe for overt signs of bleeding
d. Teach the pa how to get a Medic Alert devise
e. Obtain and record vital signs, including pulse oximetry.

A

a,c,e

45
Q

The nurse is caring for pt newly admitted with HF secondary to dilated cardiomyopathy. Which intervention would be a priority?
a. Encourage cargiver to learn CPR.
b. Consider a consulation with hospice for palliative care
c. Monitor the pt’s response to prescribed medictions
d. Arrange for the pt to enter a cardiac rehabilitation program.

A

c

46
Q

CAD
48 years old pt is found a total cholesterol level is 244,and an LDL of 140. What does the nurse teach the pt about therapeutic lifestyle change diet?SATA
a. Use fat-free milk
b.Abstain from alcohol
c. Reduce red meat in the diet
d.Eliminate intake of simple sugars
e.Avoid food prepared with egg yolks

A

a,c,e
recommendation is reducing saturated fat and cholesterol intake
b,d-if triglyceride levels are high, then reduce them

47
Q

Myocardial ischemia occurs because of increased O2 demand and decreased O2 supply. Which factors are increased O2 demand?SATA
a.Hypovolemia or anemia
b.Increased cardiac workload with aortic stenosis
c.Narrowed coronary arteries form atherosclerosis
d.Angina in the patient with atherosclerotic coronary arteries
e.Left ventricular hypertrophy caused by chronic HTN
f.Sympathetic nervous system stimulation by drugs, emotions or exertion

A

b,d,e,f
increased O2 demand is caused by increasing the workload of the heart
a,c contributes to decrease O2 supply

48
Q

What causes the pain that occurs with myocardial ischemia?
a.Death of myocardial tissue
b.Dysrhymias cause cellular irritability
c.Lactic acid accumulation during anaerobic metabolism
d.Increased pressure in the ventricles and pulmonary vessels

A

c

49
Q

What type of angina can occur in the absence of CAD? SATA
a.Silent ischemia
b.Noctural angina
c.Prinzmetal’s angina
d.Microvasular angina
e.Choronic stable angina

A

c,d
silent angina-with diabetes
Noctural -occurs only at night

50
Q

Which are describe unstable angina?SATA
a.Usually precipitated by exertion
b.New-onset angina with minimal exertion
c.Occurs only when the person is recumbent
d.Characterized by increased duration or severity
e.Usually occurs in response to coronary artery spasm

A

b,d
exercise kind of exercise
a-stable
c-angina decubitus (recumbent=横たわる)
e-Prnzmetal’s angina

51
Q

When a pt report chest pain, why must unstable angina be identified and rapidly treated?
a.The pain may be severe and disabling
b.ECG changes and dysrhythmias may occur during an attack
c.Rupture of unstable plaque may cause complete thrombosis of vessel lumen
d.Spas, of a major coronary artery may cause total occlusion of the vessel with progression to MI.

A

c
unstable angina is associated with the rupture of a once-stable atherosclerotic plaque. Pt with unstable angina need immediate hospitalization and monitoring because the lesion is at increased risk of complete thrombosis of the lumen with progression to MI

52
Q

A pt is having an evaluation of chest pain and has no abnormal serum cardiac biomarkers 4 hours after the onset of pain, What noninvasive diagnostic test can be used to differentiate angina from other types of chest pain?
a.12-lead ECG
b.Exercise stress test
c.Coronary angiogram
d.Tramsesphageal echocardiogram

A

b
c-for narrowing of conary arterise
inavsive procedure

53
Q

A 53 years old man is admitted to the ED with sever chest pain. On what basis would the nurse suspect MI?
a. He has pale, cool, clammy skin
b. He reports nausea and vomited once at home
c. He says he is anxious and has a feeling of impending doom
d. He reports he has had no relief pain with rest or position change

A

d
MI is usually unrelieved by NTG, rest, or position change and usually lasts more than the 15-20 minutes the pain.

54
Q

To detect and treat the most common complication of MI, what should the nurse do?
a. Measure hourly urine output
b. Auscultate the chest for crackles
c. Use continuous cardiac monitoring
d. Take vital every 2 hr for the first 8hr

A

c
The most complication of MI is dysrhythmias(irregular heartbeat).
Urine check and vital is for detect s/s of the complications of cardiogenic shock.
Cracks,dyspnea, and tachy may indicate the onset HF

55
Q

In the pt with chest pain, which results can distinguish unstable angina an MI?
a. ECG changes present at the pmset of the pain
b. A chest x-ray showing left ventricular hypertrophy
c. Serum tropin levels increased 4 to 6 hours after the onset
d. Creatinine kinase MB elevations that peak 6 hr after the infract

A

c
Troponin 1 and 2 are specific, release 4-6 hr after the onset on MI, and peak in 10 to 24 hours
and return to baseline over 10 to 14 days.

56
Q

Which treatment is used first for the pt with a confirmed MI to open the blocked artery whitin 90 mins of arrival to a health care?
a. TMR
b. Stent placement
c. CABG
d. PCI

A

c
Stant is the structure used to hold vessel open and require anticoagulation follwoong the orecedure. Sugical constrauction of new vessele is done with CABG

57
Q

When the pt who is diagnosed with an MI is not relieved of chest pain with IV NTG, which medication will the nurse expect to be used?
a. IV morphine sulfate
b. CCB
c. IV administration of amiodarone
d. ACR inhibitors

A

a
morphine decreases anxiety and cardiac workload as a vasodilator and reduces preload and my myocardial O2 consumption which relieves chest pain

58
Q

a) Cardiac output?
b) CO=? x ?
c) decreased CO=?
d) Insufficient(not enough)co?

A

a) the amount of blood by the heart in one minute
b) CO=HR x SV(preload, afterload and contractility)
c) Fluid overload
d) decreased end organ perfusion

59
Q

a) Preload?
b) Preload increase when?
c) Afterload?
d) Afterload increase?

A

a) the pull/stretch on the ventricle walls before the contraction
b) pregnancy
c) the force to push the blood out of the ventricles.
d) HTN

60
Q

a) Ejection Fraction?
b) normal range?
c) abnormal range?

A

a) % of blood that pumped out with each contraction
b) EF 55-75%
c) less than 40%

61
Q

How causes these system on HF?
a) RAAS system (chronic activation)?
b) The SNS (chronic activation)?

A

a) cause cardiac myocyte apoptosis (programmed cell death), hypertrophy
b) increases the myocardial O2 demand on the already weakened heart
Norepinephrine and Epinephrine are released, stimulation causes increased HR and ventricular contractility

62
Q

Systolic Failure? (HFrEF)
Causes?

A

a) Ventricles fail to contract adequately
b) Impaired contractive function (Ischemia or infarction)
increased afterload (HTN)

63
Q

Helps distinguish between HFrEF and HFpEF?

A

Ejection fraction
because HFPEF(Diastolic )’s EF range should be normal (not a contraction issue)

64
Q

BNP when does it relase?

A

Volume or pressure overload
higher means

65
Q

spironolactone
Education

A

Avoid eating foods high in potassium
Use cautiously taking digoxin d/t hyperkalemia reducing the effects of this med

Med and surg Adult (30 decks)

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