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533 Primary Care Nursing > Exam 2 > Flashcards

Exam 2 Flashcards

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1
Q

Upper right sternal border: which murmurs can be best heard here?

A

aortic valve clicks (AS), venous hum

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2
Q

Upper left sternal border: which murmurs can be best heard here?

A

pulmonary valve clicks (PS), pulmonary flow murmurs, ASD, PDA, venous hum

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3
Q

Lower left sternal border: which murmurs can be best heard here?

A

VSD, still’s murmur, tricuspid regurgitation, hypertrophic cardiomyopathy

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4
Q

Erb point: which murmurs can be best heard here?

A

aortic ejection click (AS), dilated aortic root)

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5
Q

Name the ECG

A

A Fib

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6
Q

Name the ECG

A

atrial flutter

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7
Q

Name the ECG

A

SVT

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8
Q

Name the ECG

A

Ventricular tachycardia

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9
Q

Name the ECG

A

Ventricular fibrillation

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10
Q

What are the ECG changes that occur during an anginal episode (chronic or unstable)?

A

ST segment depressions w/ symmetric T wave inversions

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11
Q

What ECG change distinguishes NSTEMI from angina?

A

ST depression longer than 48 hours

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12
Q

What ECG change occurs in a STEMI?

A

persistent ST elevation

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13
Q

Left or Right sided HF?

  • paroxysmal nocturnal dysnpea
  • pulmonary congestion
  • confusion
  • orthopnea
  • tachycardia
  • exertional dyspnea
  • fatigue
A

Left

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14
Q

Left or Right sided HF?

  • fatigue
  • ascites
  • anorexia and GI distress
  • weight gain
  • dependent edema
A

Right

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15
Q

Name the HF stage/classification:

High risk for HF but no structural heart disease or sx of HF present

A

ACC stage A

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16
Q

Name the HF stage/classification:

no limitation of physical activity

A

NYHA Class I

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17
Q

Name the HF stage/classification:

structural heart disease + prior or current s/s HF

A

Stage C

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18
Q

Name the HF stage/classification:

unable to carry on any physical activity w/o sx of HF or sx at rest

A

Class IV

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19
Q

Name the HF stage/classification:

refractory HF requiring specialized interventions

A

Stage D

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20
Q

Name the HF stage/classification:

slight limitation of physical activity, ordinary physical activity results in sx of HF

A

Stage II

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21
Q

Name the HF stage/classification:

structural heart disease w/o s/s of HF

A

Stage B

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22
Q

Name the HF stage/classification:

marked limitation of physical activity; less than ordinary activity causes sx of HF

A

Class III

23
Q

Best place to hear an aortic murmur?

A

R upper sternal border or 2nd intercostal space

24
Q

Best place to hear a pulmonic mumur?

A

left upper sternal border or 2nd intercostal space

25
Q

Best place to hear a tricuspid murmur?

A

lower left sternal border

26
Q

Best place to hear a mitral murmur?

A

apex

27
Q

Name the murmur

R sternal border, 2nd intercostal space; harsh, crescendo-decrescendo

VM decreases the murmur

A

Aortic stenosis

28
Q

Name the murmur

LLSB, loud, blowing high pitched

VM increases murmur

A

Aortic regurgitation

29
Q

Name the murmur

Pansystolic blowing at the apex

VM does not change murmur

A

Mitral regurgitation

30
Q

Name the murmur

Mid (early) or late (later s/s) systolic click and then high-pitched murmur during systole heard best at the LLSB; may be honking or clicks

Accentuated with standing

Quieter with squatting

A

MVP

31
Q

Name the murmur

low pitched diastolic rumble at the apex

VM does not change or increases murmur

A

Mitral stenosis

32
Q

Name the murmur

LLSB that is occurs some time during systole

VM reduces murmur

A

tricuspid regurgitation

33
Q

Name the murmur

4th or 5th left intercostal space, decrescendo low-itched

VM decreases murmur

A

tricuspid stenosis

34
Q

Which valvular diseases carry a risk of a.fib?

A

Mitral regurgitation and stenosis

35
Q

Which valvular diseases require immediate referral to cardio?

A

Aortic regurgitation, mitral stenosis

36
Q

What are the criteria for IE prophylaxis?

A
  • Prosthetic cardiac valves or prosthetic material used for valve repair
  • Previous IE
  • CHD
    • Unrepaired cyanotic CHD
    • Completed repaired CHD
    • Repaired CHD w/ residual defects
  • Cardiac transplantation recipients who have valve disease
37
Q

What medication is used for IE prophylaxis?

A

amoxicillin

38
Q

Name the asthma severity and the step to start at:

  • symptoms 2 days or less per week
  • 0-2 nighttime awakenings per month
  • SABA use less than 2 days per week
  • Normal FEV1 between exacerbations, FEV1 >80%, normal FEV1/FVC
  • 0-1 exacerbations requiring OCs
A

Intermittent

Start at step 1

39
Q

Name the asthma severity:

  • > 2 days per week but not daily
  • 3-4 nighttime awakenings per month
  • SABA use >2 days per week but not daily and not more than once on any day
  • Minor limitation of activity
  • FEV1 >80%; normal FEV1/FVC
  • Exacerbations 2+ times per year
A

mild persistent

Start at step 2

40
Q

Name the asthma severity

  • Daily symptoms
  • Nighttime awakenings >1x per week but not nightly
  • Daily SABA use
  • Some activity limitation
  • FEV1 60-80%; FEV1/FVC reduced 5%
  • Exacerbations 2+ times per year at least
A

Moderate persistent

Start at step 3, consider short dose of OCs

41
Q

Name the asthma severity:

  • Symptoms throughout the day
  • Nighttime awakenings 7x week
  • SABA use several times per day
  • Activity extremely limited
  • FEV1 <60%; FEV1/FVC reduced >5%
  • Exacerbations 2+ times per year at least
A

Severe persistent

start at step 4 or 5, consider short dose of OCs

42
Q

Name the level of asthma control:

  • Symptoms <2 days per week
  • Nighttime awakenings <2x per month
  • No interference with normal activity
  • SABA use <2 days per week
  • FEV1 > 80%
  • ACT >20
  • 0-1 exacerbations per year
A

Well controlled

maintain current step, consider step down if well controlled for at least 3 months

43
Q

Name the level of control:

  • Symptoms > 2 days per week
  • Nighttime awakenings 1-3x per week
  • Some activity limitation
  • SABA use > 2 days per week
  • FEV1 60-80%;
  • ACT 16-19
  • 2+ exacerbations per year
A

Not well controlled

step up 1 step and re-evaluate in 2-6 weeks

44
Q

Name the level of control:

  • Symptoms throughout the day
  • Nighttime awakenings >4x per week
  • Activity extremely limited
  • SABA use several times throughout the day
  • FEV1 <60%
  • ACT <15
  • 2+ exacerbations per year
A

Very poorly controlled

Consider short course of OCs, step up 1-2 steps and re-evaluate in 2 weeks

45
Q

What medications are indicated in step 1 of asthma treatment?

A

SABA as needed

46
Q

What medications are indicated in step 2 of asthma treatment?

A

low dose ICS, SABA PRN

47
Q

What medications are indicated in step 3 of asthma treatment?

A

low dose ICS + LABA OR medium dose ICS

SABA PRN

48
Q

What meds are indicated in step 4 of asthma treatment?

A

medium dose ICS + LABA

SARA PRN

49
Q

What medications are indicated in step 5 & 6 asthma treatment?

A

high dose ICS + LABA + OC (step 6)

SABA PRN

50
Q

Name the COPD group and treatment:

  • Low risk for exacerbation
  • Less symptoms
  • One or fewer moderate exacerbations per year
  • mMRC 0-1
A

Group A

Monotherapy w/ SABA, LAMA or LABA

51
Q

Name the COPD group and treatment:

  • Low risk for exacerbation
  • More sx
  • One or fewer moderate exacerbations per year
  • mMRC greater than or equal to 2
A

Group B

Monotherapy w/ LAMA or LABA

52
Q

Name the COPD group and treatment:

  • High risk for exacerbation
  • Less sx
  • Two+ exacerbations per year
  • mMRC 0-1
A

Group C

Monotherapy w/ LAMA

53
Q

Name the COPD group and treatment:

  • High risk for exacerbation
  • More sx
  • Two + exacerbations per year
  • mMRC 2+
A

Group D

LAMA

LAMA + LABA

ICS + LABA

533 Primary Care Nursing (4 decks)

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