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LEIK FNP Review > Cardiovascular and peripheral vascular disorders > Flashcards

Cardiovascular and peripheral vascular disorders Flashcards

1
Q

what is stage I hypertension?

list specifics for systolic and diastolic

A

systolic blood pressure greater than 130-139.

diastolic blood pressure 80-89

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2
Q

what is stage II hypertension?

list specifics for systolic and diastolic

A

systolic blood pressure greater than 130-139

diastolic blood pressure 80-89

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3
Q

what is the goal blood pressure for a patient who is less than 60 yrs old?

A

less than 140/90

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4
Q

what is the goal blood pressure for a patient who is older than 65 yrs old?

A

less than 150/90

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5
Q

what is the goal blood pressure for a patient who has chronic kidney disease and DM?

A

less than 140/90

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6
Q

which two antihypertensive agents should be used first line in African American patients?

A

thiazide diuretics and calcium channel blockers

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7
Q

what are the four antihypertensive agents that can be used first line in non-black patients?

A

Thiazide diuretics, calcium channel blocker, Ace inhibitors, and ARBs

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8
Q

which antihypertensive agent has sulfa in it?

A

thiazide diuretics are contraindicated in patients with a sulfa allergy

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9
Q

what labs should be checked for a patient that is on an ace inhibitor or an ARB?
list three labs

A

potassium, BUN, creatinine

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10
Q

what lab should be checked for a patient that is on a thiazide diuretic?

A

potassium

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11
Q

which two statin drugs would you prescribe for a patient that has a history of coronary heart disease or stroke (CVA)? list two statin meds

A

Atorvastatin, Rosuvastatin (think AR 40-80)
you want a 50% reduction in LDL

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12
Q

For patients with a history of DM, aged 40 to 75, with an LDL of 70-189, what intensity of a statin is recommended?

A

moderate intensity statin

atorvastatin 10-20, rosuvastatin 5-10, simvastatin 10-20, pravastatin 20-40

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13
Q

what is the ASCVD goal risk percentage to be Below ?

A

Be below 7.5%
start a statin if higher than 7.5%

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14
Q

when should you initiate a fibrate with a statin medication?

A

only if the triglycerides are over 500.

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15
Q

what is important to acknowledge in patient who use a NSAID such as naproxen in patients with hypertension?

A

It can cause swelling, it changes how kidneys handle sodium.

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16
Q

what antihypertensive class of medication should NOT be used in heart failure patients?

A

calcium channel blockers (example amlodipine)

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17
Q

what heart sound is most common with heart failure?

A

S3

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18
Q

When you hear “a searing or tearing back pain” what should you think of?

A

Abdominal aortic aneurysm

common finding is a “pulsatile mass” in the abdomen in asymptomatic cases

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19
Q

At how many cm is an AAA diagnosed?

A

at 3 cm

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20
Q

what is the screening recommendation for AAA?

A

screen MEN aged 65 to 75 years of age who have Ever smoked ONE time with ultrasonography

**ever smoked is commonly defined as smoking 100 or more cigarettes

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21
Q

stenotic valves have what trouble?

A

don’t open properly

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22
Q

Reguritant valves have what trouble?

A

they don’t close properly

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23
Q

List all the systolic murmurs

(think MR. Peyton Manning AS MVP)

A

Mitral Regurgitation
Physiologic Murmur
Aortic Stenosis
Mitral Valve Prolapse

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24
Q

List all the diastolic murmurs

(think has big “ARMS”)

A

Aortic Regurgitation
Mitral Stenosis

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25
Q

where is aortic stenosis best heard?

(remember we tend to hear murmurs best where they originate)

A

2nd right intercostal space

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26
Q

which systolic murmur has a mid-systolic click?

A

Mitral valve prolapse

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27
Q

which systolic murmur has a holosystolic murmur?

A

Mitral regurgitation

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28
Q

Ankle brachial index value less than ____ and greater than ____ suggests peripheral artery disease.

A

Ankle brachial index valve less than 0.9 and greater than 1.3 suggests peripheral artery disease

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29
Q

The “lub” sound is what heart sound?

A

S1

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30
Q

S1 or the “lub” sound is the closure of what two valves?

(think Motivated Apples)

A

closure of the mitral, tricuspid, and AV valves

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31
Q

The “dub” sound is what heart sound?

A

S2

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32
Q

S2 or the “dub” sound is the closure of what two valves?

(think motivated apples)

A

closure of the aortic, pulmonic, and semilunar valves

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33
Q

which heart sound is associated with systole?

A

S1

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34
Q

which heart sound is associated with diastole?

A

S2

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35
Q

S3 heart sound is associated with what?

A

heart failure, often heard as a gallop

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36
Q

S3 heart sound can be a normal finding in children, pregnant women and some athletes younger than 35 yrs, true or false?

A

TRUE

37
Q

which heart sound occurs in LATE diastole?

A

S4
sounds like tennesse

38
Q

which heart sound occurs in LATE diastole?

A

S4
sounds like Tennessee

39
Q

how is S4 best heard?

A

with the bell of the stethoscope

40
Q

which heart sound occurs in early diastole?

A

S3

41
Q

To hear low tones of the stethoscope, which side of the stethoscope would you use?

A

use the bell of the stethoscope

42
Q

To hear mid to high-pitched tones such as lung sounds, which side of the stethoscope would you use?

A

diaphragm

43
Q

what murmur is this:

A very soft murmur heard only under optimal conditions

A

Grade I

44
Q

what murmur is this:

Murmur is so loud that it can be heard even with the stethoscope off the chest. The thrill is easily palpated.

A

Grade VI

45
Q

what murmur is this :

Very loud murmur heard with edge of stethoscope off the chest. Thrill is more obvious.

A

Grade V

46
Q

what murmur is this:

A louder murmur. First time that a thrill is present. A thrill is like a “palpable murmur.”

A

Grade IV

47
Q

what murmur is this:

A mild to moderately loud murmur

A

Grade II

48
Q

what murmur is this:

Loud murmur that is easily heard once the stethoscope is placed on the chest.

A

Grade III

49
Q

what grade of murmur is first palpated?

A

Grade IV (4)

50
Q

which heart sound is a sign of LVH?

A

s4

51
Q

what is the recommended INR range for a patient who has A-fib?

A

2.0 to 3.0

52
Q

what is the recommended INR range for a patient who has had synthetic or prosthetic heart valve?

A

2.5 to 3.5

53
Q

what is pulsus paradoxus?

A

defined as a fall in systolic BP of more than 10 mmhg during the inspiratory phase

54
Q

pulsus paradoxus is associated with what cardiac condition?

A

cardiac tamponade

55
Q

IF INR is between 4.01 and 4.99, what is the action the provider should do?

A

Hold one dose, do not give vitamin K

56
Q

what is a normal PR interval?

A

0.12 to 0.20

(3-5 small boxes)

57
Q

S3 heart sound is common in what trimester of pregnancy?

A

third trimester

58
Q

what drugs are used to control or manage blood pressure in pregnancy? list 3

A

methyldopa, nifedipine, and labetalol (metoprolol)

59
Q

Hypertensive retinopathy has what characteristic?

A

silver and/or copper wire arterioles
flame-shaped hemorrhages, papilledema

60
Q

what are some causes of secondary hypertension?

A

renal artery stenosis, polycystic kidney disease, CKD, hyperthyroidism, hyperaldosteronism, pheochromocytoma, OSA, cortication of the aorta

61
Q

renal artery stenosis is more common in what population?

A

younger adults

62
Q

what is orthostatic hypotension?

A

Decrease in systolic blood pressure by 20 mmhg or decrease in diastolic blood pressure by 10mmhg.

63
Q

when should you reassess blood pressure in patients that you initiate a med on for the first time?

A

in one month

64
Q

what are side effects of thiazide diuretics ?

A

hyperglycemia
hyperuricemia
hypertriglyceridemia
hypercholesteremia

hypokalemia
hyponatremia
hypomagnesemia

65
Q

what are side effects of calcium channel blockers?

A

headaches (due to vasodilation), ANKLE EDEMA, heart block or bradycardia, reflex tachycardia

66
Q

calcium channel blockers are contraindicated in what conditions?

A

bradycardia
second-third degree heart block
CHF

67
Q

what are two biggest side effects of alpha 1 blockers/antagonists?

A

dizziness and hypotension

68
Q

what medications can be used for BPH and hypertension?

A

Terazosin and Doxazosin

69
Q

Flomax or tamulosin is just used for BPH only.

A

true

70
Q

Aliskiren should not be given with what two antihypertensive classes?

A

ACE inhibitors or ARBs

71
Q

what is a side effect of spironolactone ?

A

gynecomastia

72
Q

what is the concern when combining an ACE inhibitor and a potassium sparing diuretic?

A

hyperkalemia is at an increased risk

73
Q

what antihypertensive class should not be used in patients with renal artery stenosis?

A

ACE inhibitors and ARBs will precipitate acute renal failure

74
Q

women with hypertension and osteopenia/osteoporosis should receive what class of antihypertensive meds?

A

thiazide diuretics

because thiazides help bone loss by slowing down calcium loss (from the bone) and stimulating osteoclasts

75
Q

what is homan’s sign?

A

lower leg pain on dorsiflexion of the foot (low sensitivity test)

76
Q

what is homan’s sign associated with?

A

DVT

77
Q

what is the gold standard for diagnosis DVT?

A

Ultrasonography

78
Q

what is the first line medication for a stable heart failure patient?

A

ACE inhibitor or ARB

79
Q

NY association functional capacity rating:

“No limitations on physical activity”

A

class I

80
Q

NY association function capacity rating:

“symptoms are present at rest, with or without physical activity”

A

class IV

81
Q

NY association function capacity rating:

“Ordinary physical activity results in fatigue, exertional dyspnea”

A

Class II

82
Q

NY association function capacity rating:

“Marked limitation in physical activity”

A

Class III

83
Q

in patients with peripheral arterial disease, how do legs look?

A

Red in dependent position, white/pallor in elevated position.
Shiny skin, hyperpigmented ankles, hairless, and cool to the touch.

84
Q

what are some medications used to treat Raynaud’s phenomenon?

A

nifedipine or amlodipine

85
Q

Subungual hemorrhages is associated with what heart condition?

A

Bacterial endocarditis

86
Q

a mid-systolic click by a a late systolic murmur is most likely which heart murmur?

A

mitral valve prolapse

87
Q

what is the triad of rhabdomyolysis?

A

triad of muscle pain (myalgia), weakness, and red to brown urine.

88
Q

An adult (21 to 75 yrs) with any type of ASCVD (CAD, PAD, Stroke, TIA) is given what type of statin strength?

A

high intensity statin

89
Q

Patients on a statin should avoid what?

A

grapefruit juice

LEIK FNP Review (19 decks)

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