Cardiovascular System Part 2

Question 1

What is hypertension?

Answer 1

Hypertension is a sustained elevation in blood pressure that will result in end organ damage and vessel changes. Normal systolic blood pressure (top number) should be less than 120 and normal diastolic blood pressure (bottom number) should be less than 80.

Question 2

Most patients with elevated blood pressure are asymptotic what are the risk factors associated with untreated hypertension or a patient who does not want to take blood pressure medication due to side effects?

Answer 2

-RF (Renal failure)
-CAD (Coronary artery disease)
-CVA (Stroke)
-Vision loss
-HF (Heart failure)

Question 3

What are some modifiable risk factors for hypertension and what would the nurse want to teach the patient about these risk factors?

Answer 3

-Diet (change to a low cholesterol, low sodium heart healthy diet)
-Smoking (advise on smoking cessation)
-Alcohol (advise on ETOH cessation)
-Obesity (advise on daily exercise)

Question 4

What is preeclampsia?

Answer 4

Preeclampsia is a blood pressure that is elevated above 140/90 in pregnancy and produces impaired renal function, impaired liver function, pulmonary edema, vision disturbances, and decreased platelet counts.

Question 5

What assessment findings would you anticipate in a patient who has been diagnosed with preeclampsia?

Answer 5

Reports of vision changes (double vision, stars in vision, floaters)
Headache
Nausea / vomiting
Decreased urine output
Bilateral lower extremity edema
Protein in the urine
Low platelet count
High creatinine level (renal function test)
High liver function tests (due to liver impairment)

Question 6

What is the is the serious complication that can occur in preeclampsia-eclampsia and result in death in the mother and child if not treated immediately?

Answer 6

HELLP syndrome

Question 7

What is the treatment of preeclampsia?

Answer 7

Delivery of the child.
Magnesium can be given to prevent seizures in the mother and for the neuroprotective effects it can have on the unborn child until delivery is safe to perform.

Question 8

What drug class of medication would you expect a client diagnosed with hypercholesterolemia (high cholesterol) to be given?

Answer 8

Statins

Question 9

What is a DVT (deep vein thrombosis)?

Answer 9

A DVT is the presence of a clot (thrombus) in a vein and the inflammatory response that occurs as a result.

Question 10

What assessment findings would the nurse anticipate in a client diagnosis with a DVT (deep vein thrombosis)?

Answer 10

The nurse would expect the client to complain of pain at the site of the DVT. The nurse would anticipate that the client would have tenderness over the area where the DVT is located along with skin redness, and edema. A fever may be present.

Question 11

What is the most severe life-threatening complication of a DVT (deep vein thrombosis)?

Answer 11

PE (Pulmonary embolism) which is a clot in the patient’s lungs

Question 12

What are the risk factors for development of a DVT (deep vein thrombosis)?

Answer 12

Sedentary lifestyle
Prolonged rest (Hospitalization or bedrest)
Surgery
Pregnancy
Smoking
Estrogen containing birth control pills

Question 13

What medication treatment would the nurse anticipate for a client diagnosed with a DVT (deep vein thrombosis)?

Answer 13

Anticoagulants

Question 14

What are some non-pharmacologic methods the nurse can teach the client who is hospitalized to prevent a DVT from occurring?

Answer 14

Promotion of early ambulation (walking) and usage of SCD’s

Question 15

What is a cardiac tamponade?

Answer 15

A rapid filling of the pericardial sac which compresses the heart

Question 16

What symptoms would the nurse anticipate in a client with a suspected cardiac tamponade?

Answer 16

Anxiety, chest pain, difficulty breathing, increased heart rate, JVD, low SBP (systolic blood pressure), and muffled heart sounds.

Question 17

What treatment is preformed for a cardiac tamponade and what would occur if treatment is delayed or not completed?

Answer 17

Pericardiocentesis is performed for treatment and if not completed the patient will progress to circulatory shock and impending death

Question 18

What is a pericardial effusion?

Answer 18

A pericardial effusion is an accumulation of fluid in the pericardial cavity from inflammation or infection.

Question 19

What is the most serious complication of a pericardial effusion?

Answer 19

Cardiac Tamponade from the increased pressure the fluid accumulating in the pericardial sac is placing on the heart

Question 20

What symptoms would the nurse anticipate in a patient diagnosed with a pericardial effusion?

Answer 20

Chest pain
Feeling faint
Chest fullness
Shortness of breath
Difficulty breathing when lying flat

Question 21

What symptoms would the nurse anticipate in a client diagnosed with right sided heart failure?

Answer 21

Fatigue
Pitting edema in lower extremities
JVD
Anorexia
GI complaints
Weight gain
Ascites
Enlarged liver and spleen

Question 22

What symptoms would the nurse anticipate in a client diagnosed with left-sided heart failure?

Answer 22

Fatigue
Confusion
Restlessness
Cyanosis
Orthopnea
Exertional shortness of breath
Tachycardia
Chronic cough
Wheezes, crackles, blood tinged sputum

Question 23

What is a normal EF and what is considered abnormal?

Answer 23

EF is an ejection fraction which is determined by how much blood in the ventricle is pumped out with each beat.

Normal is 50% to 75%
41% to 49% is borderline and symptoms of HF may occur with activity
Heart failure symptoms will be present at rest and activity with a EF of 40% or less. These patients are also at a higher risk for complications

Question 24

Digoxin can be given in a patient with heart failure to improve the patient’s condition. This medication can become toxic if the dosage is not monitored. What does this medication do to improve the patient’s symptoms?

Answer 24

This medication will increase the force and contraction of the ventricles.

Question 25

As heart failure progresses and treatment options begin to fail what would the nurse anticipate the patient with end-stage heart failure will require?

Answer 25

A heart transplant

Question 26

What medication class can be given in a heart failure patient to reduce excessive fluid volume in the patient

Answer 26

Diuretics

Question 27

What symptoms would the nurse anticipate in a client with stable angina?

Answer 27

Chest pain occurring at a predictable pattern that is relieved with rest and/or nitroglycerin

Question 28

What would alert the nurse that a client may be experiencing a STEMI?

Answer 28

ST elevation on EKG
Elevated cardiac enzymes (cardiac markers such as troponin)
Abrupt onset of symptoms
Severe and crushing pain in the chest
Pain may radiate to the left jaw or left neck.
GI symptoms of nausea and vomiting
Fatigue / weakness
Tachycardia, anxiety, restlessness, feelings of impending doom
Pale, cool, and moist skin

Question 29

The nurse understands that the abnormal condition rhythm known as a-fib (atrial fibrillation) results in what happening in the client’s heart?

Answer 29

A-fib results in the atrium quivering rather than contracting appropriately which causes stagnant blood flow. Stagnation of blood flow will produce clots in clients with a-fib.

Question 30

A client diagnosed with a-fib is at a high risk for developing clots. Treatment of a-fib includes prescription of what two drug classes?

Answer 30

Beta-blockers (for rate control) and anticoagulants (reduce clotting risk)

Question 31

In a client who is experiencing ventricular fibrillation the nurse understands that what is happening in the client’s heart?

Answer 31

The nurse understands that the client’s rhythm is originating in the ventricles rather than the SA node. This results in the ventricles quivering rather than contracting as they should. Since the right ventricle pumps blood to the lungs for oxygenation and the left ventricle pumps blood to systemic circulation this means the client will not have effective blood flow to the body and will die if the rhythm is not corrected.

Question 32

A client has recently experienced a heart attack and when the nurse assesses the cardiac monitor she notes ventricular fibrillation. The nurse understands this is a medical emergency and the patient requires what immediate treatment?

Answer 32

Ventricular fibrillation requires immediate defibrillation. Hint: think v-fib = d-fib every time.

Question 33

The electrical impulse for a normal sinus rhythm in the heart originates in what area and produces a normal heart rate of how many beats a minute?

Answer 33

The electrical impulse should originate in the SA node which is the pacemaker of the heart. This should produce a heart rate of 60 to 100 beats a minute. If the heart rate is too high this is considered tachycardia and if the heart rate is too low this is bradycardia.

Question 34

In a client diagnosed with shock the nurse would anticipate the following symptoms:

Answer 34

Altered level of consciousness
Pale or bluish discoloration of the skin
Cool and moist skin
Restlessness or irritability
increased thirst
Rapid and weak pulse (Tachycardia = HR greater than 100 beats a min)
Rapid breathing (Tachypnea = rate greater than 24 breaths a minute)
Nausea or vomiting

Question 35

A client is experiencing anaphylactic shock related to a peanut allergy. What treatment should the nurse rapidly administer?

Answer 35

Anaphylactic shock should be treated with epi administered as quickly as possible. The nurse should additionally call 911 if he/she is not in the hospital and maintain an open airway in the client.

Question 36

Cardiogenic shock is failure of the heart to pump blood sufficiently to meet the body’s demands. An acute event that result in cardiogenic shock would be?

Answer 36

Myocardial infarction (MI), cardiac contusion, and sudden change from sinus rhythm to an arrhythmia such as ventricular fibrillation.

Question 37

The nurse understands that the symptoms of Kawasaki disease include the following:

Answer 37

Acute onset of fever that is often 104 degrees and is unresponsive to antibiotic treatment
Measles like rash
Enlarged lymph node
Redness of the sclera (white part) of the eye
After the fever resolves the skin on the hands and feet will begin to peel off