Exam 2 - Cardio

Question 1

How do beta blockers work?

Answer 1

Beta-blockers slow down your heart rate and reduce the force at which blood is pumped round your body (cardiac afterload)

Question 2

Which is the first elevated substance during MI?

Answer 2

Troponin

Question 3

Main cardiac enzymes

Answer 3

SGOT
LDH (LD)
CPK (CK)
Troponin

All go up following MI (can take up to 6 hours to elevate enough to be noticed)

Question 4

Blood pressure medicine that ends in “ide”

Answer 4

Thiazide diuretics

Remove unwanted fluid from the body, which helps lower blood pressure

Question 5

Blood pressure medicine that ends in “pine”

Answer 5

Calcium channel blockers

Make the artery walls relax, making them wider, which lowers blood pressure

Question 6

Blood pressure medicine that ends in “artan”

Answer 6

Angiotensin receptor blockers (ARBs)

Control hormones that affect blood pressure

Question 7

Blood pressure medicine that ends in “pril”

Answer 7

ACE inhibitors

Help to control hormones that affect blood pressure

Question 8

Coarctation of the aorta

Physical assessment findings / What happens above and below the area of coarctation?

Answer 8

• Higher blood pressure in upper extremities than the lower extremities
• Bounding pulses in arms
• Weak or absent femoral pulses
• Cool lower extremities
• Headache

Question 9

Aortic stenosis

Answer 9

• Narrowing of aortic valve, causing resistance to blood flow from LV into aorta
• Characteristic murmur is present
• Increased afterload/work of LV
• Decreased cardiac output, left vent hypertrophy, pulmonary vascular congestion

Question 10

Which health disorder lead to aortic regurgitation

Answer 10

• Result of an incompetent aortic valve that allows blood to flow back to the left ventricle during diastole
• May result from conditions that cause scarring of the valve leaflets or from enlargement of the valve orifice to the extent that the valve leaflets no longer meet
• Rheumatic fever, idiopathic dilation of the aorta
• Congenital abnormalities
• Infective endocarditis
• Marfan syndrome

Question 11

Which health disorders lead to mitral regurgitation

Answer 11

• Most commonly from mitral valve prolapse
• Rheumatic heart disease is associated with rigid and thickened valve that does not open or close completely
• Rupture of chordae tendonae and papillary muscles, papillar muscle dysfunction, or stretching of the valve structures due to dilation of LV or valve orifice

Question 12

Which health disorders lead to mitral stenosis

Answer 12

• Most commonly result of rheumatic fever

- Less common: congenital and manifests during infancy or early childhood

Question 13

Varicose Veins – what changes occur within the veins?

Answer 13

• Dilated, tortuous veins
• Prolonged exposure to increased pressure causes the venous valves to become incompetent so they no longer close properly
• Reflux of blood causes further venous enlargement – pulls valve leaflet apart, causing more valvular incompetence
• Secondary – flow in the deep channels is impaired/blocked (most common cause is deep vein thrombosis)

Question 14

Raynaud Phenomenon/Disease – Pathophysiology & clinical manifestations

Answer 14

• Affects otherwise healthy women
• Hyperreactivity of sympathetic nervous system has been suggested as contributing cause
• Vasospasm of arterioles and arteries of upper & lower extremities
• Vasospasm causes constriction of the cutaneous vessels
• Attacks are intermittent and occur with exposure to cold or stress
• Affects primarily fingers, but can affect toes, ears, cheeks
• Fingers start becoming white – then blue – then red
• (PAD disease)

Question 15

Stable angina

Answer 15

Pain when heart’s oxygen demand increases
o Occurs with activities that involve exertion or emotional stress; relieved with rest or nitroglycerin
o Pain described as constricting, squeezing, or suffocating sensation
o Usually steady pain, increasing in intensity only at the onset and end of the attack
o Pain commonly located in the precordial or substernal area of the chest
o Similar to MI in that it may radiate to the left shoulder, jaw, arm, or other areas of the chest

Question 16

Unstable angina

Answer 16

Does not follow a pattern
o Occurs with an unpredictable degree of exertion or emotion and increases in occurrence, duration, and severity over time
o No evidence of serum markers for myocardial damage
o Occurs at rest or with minimal exertion, severe, frank pain

Question 17

Variant angina

Answer 17

Pain when coronary arteries spasm
o Results from coronary artery spasm – may occur at rest or with minimal exercise, and frequently occurs nocturnally
o Arrhythmias often occur when the pain is severe, and most persons are aware of their presence during an attack
o ECG changes significant – ST-segment elevation or depression, T-wave peaking, inversion of U-waves, and rhythm disturbances

Question 18

Silent myocardial ischemia

Answer 18

Myocardial ischemia without pain
o Impaired blood flow from the effects of coronary atherosclerosis or vasospasm
o 3 populations – persons who are asymptomatic without other evidence of CAD, persons who have had an MI and continue to have episodes of silent ischemia, persons with angina who also have episodes of silent ischemia
o Ischemic episodes may be shorter and involve less myocardial tissue than those producing pain

Question 19

Nursing management for MI

Answer 19

• Administer Aspirin to patient
• Put patient to bed to reduce the amount of oxygen requirement for the affected area of myocardium
• Pain management: Reducing as much pain as possible for the patient
• Oxygen therapy

Question 20

Endocarditis – Risk factors

Answer 20

• IV drug users or alcohol use
• Immunodeficiency, malignancy, or therapeutic immunosuppression
• Diabetes
• Has had valve replacements or repair of valves with prosthetic materials
• Other structural cardiac defects
• Occult source into the oral cavity or gut

Question 21

Left Heart Failure—Clinical manifestations (S/S)

Answer 21

Left ventricle cannot maintain adequate cardiac output to the body – pressure backs up into the lungs

• Tachycardia
• Dypsnea, orthopnea, nocturia
• Decreased cerebral perfusion
• Pulmonary congestion and edema (crackles may be heard on auscultation)
• Urine output less than 30 mL/hr
• Cool, clammy extremities
• Excessive fatigue
• Coughing, wheezing, tachypnea, frothy sputum
• Systolic – not enough blood pumped to body
• Diastolic – not enough blood from lungs

Question 22

Right Heart Failure—Clinical manifestations (S/S)

Answer 22

Right ventricle cannot handle the venous return – pressure backs up into the venous system

• Peripheral edema
• Jugular vein distention
• Ascites hepatomegaly, pain in upper right quadrant
• Weight gain
• Tachycardia
• Clear lungs, paradoxical pulse (BP increases on expiration)

Question 23

ECG changes during an acute myocardial infarction (NOT ischemia)

Answer 23

• ST elevation MI (STEMI), T wave inversion
• An abnormal Q wave may also be present
• Hours to days after the MI, ST and T wave changes will return to normal but the Q wave changes usually remain permanently

Question 24

Buerger disease – Clinical manifestations

Answer 24

• Occlusive disease of median and small arteries and veins
• Distal upper and lower limbs are affected most commonly
• Typically affects young men who smoke
• Affects digital, tibial, plantar, ulnar, palmar arteries
• Symptoms:
  o Intermittent claudication
  o Affects primarily toes – tenderness and hair loss in affected area
  o Ischemic pain occurring in the digits while at rest
  o Aching pain that is more severe at night
  o Cool, numb, or tingling sensation
  o Diminished pulses in the distal extremities
  o Extremities that are cool and red in the dependent position
  o Development of ulcerations in the extremities
  o Can lead to gangrenous lesions

Question 25

Hypertension – What is the “basic pathophysiology” of primary/essential hypertension?

Answer 25

• Probable multiple genetic causes, but for now the cause is unknown

Question 26

Deep Vein Thrombosis (DVT) – Clinical manifestations (S/S)

Answer 26

• Obstructive venous flow, causes increased pressure
• Pain
• Deep muscle tenderness

Question 27

Aneurysm – Clinical manifestations (S/S) of abdominal versus cerebral

Answer 27

Abdominal aneurysm:
-	Most common, especially after age 50
-       Pulsating feeling near the navel
-	Deep constant pain in abdomen or on side of abdomen
-	Back pain
Cerebral aneurysm (ruptured):
-	Sudden, severe headache
-	Nausea & vomiting
-	Stiff neck
-	Blurred or double vision
-	Sensitivity to light
-	Seizure
-	Drooping eyelid
-	Loss of consciousness
-	Confusion
Leaking cerebral aneurysm ONLY extremely severe headache
Unruptured cerebral aneurysm: pain above/behind an eye, dilated pupil, change in vision/double vision; numbness/weakness/paralysis on side of face; drooping eyelid

Question 28

Coronary Artery Disease (CAD) – Risk factors

Answer 28

• Age
• Gender (males)
• Family history
• Smoking
• High cholesterol
• Poor eating habits
• Sedentary lifestyle
• Stressful environment

Question 29

Peripheral Artery Disease (PAD)

Answer 29

• Involves narrowing and obstruction of the arteries, especially in the lower extremities. The chronic arterial obstruction progressively leads to decreased oxygen delivery to the tissues (by the time symptoms occur, artery is approx. 85-95% occluded)
• Clinical manifestations (S/S)
  o Often asymptomatic
  o May have intermittent claudication, pain/cramps when walking

Question 30

A client admitted to the hospital with chest pain and history of type 2 diabetes mellitus is scheduled for cardiac catheterization. Which of the following medications would need to be withheld for 48 hours before and after the procedure?

1. Regular insulin
2. Glipizide (Glucotrol)
3. Repaglinide (Prandin)
4. Metformin (Glucophage)

Answer 30

4
Metformin (Glucophage) needs to be withheld 48 hours before and after cardiac catheterization because of the injection of contrast medium during the procedure. If the contrast medium affects kidney function, with metformin in the system, the client would be at increased risk for lactic acidosis. The medications in options 1, 2, and 3 do not need to be withheld 48 hours before or after cardiac catheterization.

(Yellow book)

Question 31

A client with myocardial infarction suddenly becomes tachycardic, show signs of air hunger, and begins coughing frothy, pink-tinged sputum. Which of the following would the nurse anticipate when auscultating the client’s breath sounds?

1. Stridor
2. Crackles
3. Scattered rhonchi
4. Diminished breath sounds

Answer 31

2
Pulmonary edema is characterized by extreme breathlessness, dyspnea, air hunger, and the production of frothy, pink-tinged sputum. Auscultation of the lungs reveals crackles. Rhonchi and diminished breath sounds are not associated with pulmonary edema. Stridor is a crowing sound associated with laryngospasm or edema of the upper airway.

(Yellow book)

Question 32

A client is having frequent premature ventricular contractions. A nurse would place priority on assessment of which of the following?

1. Sensation of palpitations
2. Causative factors, such as caffeine
3. Precipitating factors, such as infection
4. Blood pressure and oxygen saturation

Answer 32

3
Premature ventricular contractions can cause hemodynamic compromise. The shortened ventricular filling time with the ectopic beat leads to decreased stroke volume and, if frequent enough, to decreased cardiac output. The client may be asymptomatic or may feel palpitations. Premature ventricular contractions can be caused by cardiac disorders, states of hypoxemia, or by any number of physiological stressors, such as infection, illness, surgery, or trauma, and by intake of caffeine, nicotine, or alcohol.

(Yellow book)

Question 33

A client has developed atrial fibrillation, with a ventricular rate of 150 beats/min. The nurse should assess the client for which associated signs or symptoms?

1. Flat neck veins
2. Nausea and vomiting
3. Hypotension and dizziness
4. Hypertension and headache

Answer 33

3
The client with uncontrolled atrial fibrillation with a ventricular rate more than 100 beats/min is at risk for low cardiac output because of loss of atrial kick. The nurse assesses the client for palpitations, chest pain or discomfort, hypotension, pulse deficit, fatigue, weakness, dizziness, syncope, shortness of breath, and distended neck veins.

(Yellow book)

Question 34

A nurse is caring for a client who had a resection of an abdominal aortic aneurysm yesterday. The client has an intravenous infusion with a rate of 150 mL/hr, unchanged for the last 10 hours. The client’s urine output for the last 3 hours was 90, 50, and 28 mL (28 mL most recent). The client’s blood urea nitrogen level is 35 mg/dL and serum creatinine level is 1.8 mg/dL, measured this morning. Which of the following actions should the nurse take next?

1. Call the physician.
2. Check the urine specific gravity.
3. Check to see if the client had a sample for serum albumin level drawn.
4. Put the intravenous line on a pump so that the infusion rate is sure to stay stable.

Answer 34

1
Following abdominal aortic aneurysm resection or repair, the nurse monitors the client for signs of renal failure. Renal failure can occur because often much blood is lost during the surgery and, depending on the aneurysm location, the renal arteries may be hypoperfused for a short period during surgery. The nurse monitors hourly intake and output and notes the result of daily blood urea nitrogen and creatinine levels. Urine output lower than 30 to 50 mL/hr is reported to the physician.

(Yellow book)

Question 35

A client with angina complains that the anginal pain is prolonged and severe and occurs at the same time each day, most often at rest in the absence of precipitating factors. How would the nurse best describe this type of anginal pain?

1. Stable angina
2. Variant angina
3. Unstable angina
4. Nonanginal pain

Answer 35

2
Variant angina, or Prinzmetal’s angina, is prolonged and severe and occurs at the same time each day, most often at rest. Stable angina is induced by exercise and relieved by rest or nitroglycerin tables. Unstable angina occurs at lower and lower levels of activity at rest, is less predictable, and is often a precursor of myocardial infarction.

(Yellow book)

Question 36

A nurse in a medical unit is caring for a client with heart failure. The client suddenly develops extreme dyspnea, tachycardia, and lung crackles and the nurse suspects pulmonary edema. The nurse immediately ask another nurse to contact the physician and prepares to implement which priority interventions? Select all that apply.

1. Administering oxygen
2. Inserting a foley catheter
3. Administering furosemide (Lasix)
4. Administering morphine sulfate intravenously
5. Transporting the client to the coronary care unit
6. Placing the client in a low Fowler’s side-lying position

Answer 36

1, 2, 3, 4
Pulmonary edema is a life-threatening event that can result from severe heart failure. In pulmonary edema, the left ventricle fails to eject sufficient blood, and pressure increases in the lungs because of the accumulated blood. Oxygen is always prescribed, and the client is placed in a high Fowler’s position to ease the work of breathing. Furosemide, a rapid-acting diuretic, will eliminate accumulated fluid. A Foley catheter is inserted to measure output accurately. Intravenously administered morphine sulfate reduces venous return (preload), decreases anxiety, and also reduces the work of breathing. Transporting the client to the coronary care unit is not a priority intervention. In fact, this may not be necessary at all if the client’s response to treatment is successful.

(Yellow book)

Question 37

A client has had her blood pressure evaluated weekly for 1 month. At the end of the month, the nurse averages out the weekly blood pressures at 150/96 mm Hg. The client is 20 pounds overweight, and her cholesterol is 240 mg/dL. What is important information for the nurse to include in the teaching plan for this client?

1. Refer her to the doctor for further follow-up and medications.
2. Increase the fiber in her diet and begin a daily 30-minute workout.
3. Reduce her sodium intake and decrease the dietary calories that come from fat.
4. Reduce her cholesterol intake for 1 month and check her BP 3 times a week.

Answer 37

1
The client should be referred for further evaluation of blood pressure. The blood pressure is definitely elevated, the client is overweight, and she has an increased level of cholesterol. A multifocal approach is necessary to control the blood pressure. Because of the multiple risk factors, increasing fiber in the diet and exercise would not likely be sufficient to reduce the hypertension. Neither would dietary changes. This patient needs a multifocal approach.
(Illustrated, p 361)

Question 38

A client with hypertension asks the nurse what type of exercise she should do each day. What is the nurse’s best response?

1. “Exercise for an hour, but only three times a week.”
2. “Walk on the treadmill for 45 minutes every morning.”
3. “Begin walking and increase your distance as you can tolerate it.”
4. “Exercise only in the morning and stop when you get tired.”

Answer 38

3
When any client begins exercising, it should be gradually with increasing activity as the client tolerates it. A complication of hypertension is heart failure, which may be first seen as dyspnea on exertion. The client should exercise as tolerated and stop when she gets tired or begins to have shortness of breath, regardless of the amount of time she has already exercised.
(Illustrated, p 361)

Question 39

The nurse is caring for a client with right-side heart failure. What nursing assessment information correlates with an increase in venous pressure?

1. Jugular vein distention with client sitting at a 45-degree angle
2. Crackling sounds over the lower lobes with client in upright position
3. Bradycardia, restlessness, and an increase in respiratory rate
4. Decreased pulsations at the point of maximum impulse

Answer 39

1
Jugular vein distention with the client in a sitting position, or with a 45-degree head elevation, is indicative of an increase in the central venous pressure. Many clients experience jugular vein distention when in a supine position, and this is not indicative of an increase in central venous pressure. Adventitious breath sounds, bradycardia, restlessness, and tachypnea are not directly associated with increased jugular vein distention but may occur if the client develops right-sided heart failure.
(Illustrated, p 397)

Question 40

The nurse is administering nitroglycerin intravenously to relieve chest pain. What is the therapeutic action of this medication?

1. Increase glomerular filtration, which results in decreased venous return
2. Enhances contractility of the myocardium, which increases oxygen delivery
3. Produces an immediate analgesic effect and relieves chest pain
4. Increases the coronary blood supply and decreases the afterload

Answer 40

4
Nitroglycerin is a vasodilator. It dilates the coronary arteries, thereby increasing myocardial blood supply; vasodilation of the peripheral circulation decreases the pressure against which the heart must pump (decreases afterload) and, by dilating the venous system, allows blood to pool in the venous system (decreases preload). Glomerular filtration may increase from an increased cardiac output, but the primary purpose is to increase blood supply to the myocardium. The vasodilation will also assist to relieve chest pain, but it does so through increased blood supply to myocardium.

(Illustrated, p 397)

Question 41

In discharge planning for the client with heart failure, the nurse discusses the importance of adequate rest. What information is most important?

1. A warm, quiet room is necessary
2. Bed rest promotes venous return
3. A hospital bed is necessary
4. Adequate rest decreases cardiac workload

Answer 41

4
To help decrease pulmonary congestion and dyspnea, the nurse should encourage adequate rest to decrease cardiac workload; the client should not exert himself to the point of fatigue. Bed rest does promote venous return, but that is not the purpose of bed rest in the client with heart failure. A hospital bed is not necessary, and a quiet room is important if that is what promotes rest for the client.

(Illustrated, p 397)

Question 42

The nurse is assessing a client whose condition is being stabilized after experiencing an acute coronary syndrome (myocardial infarction).What finding on the nursing assessment would indicate inadequate renal perfusion?

1. Decreasing serum blood urea nitrogen (BUN) level
2. Urine specific gravity of less than 1.010
3. Urine output of less than 30 mL/hr
4. Low urine osmolarity and creatinine clearance

Answer 42

3
A sustained low cardiac output decreases renal perfusion and results in oliguria and impaired renal function. Oliguria is marked by output of less than 30 mL/hour. Increased BUN, changes in specific gravity (osmolarity), and creatinine clearance will be affected if the client develops renal failure.

(Illustrated, p 397)

Question 43

The nurse has been assigned a group of cardiac clients. What would be the most important information for the nurse to check on the initial evaluation of each client? Select all that apply:

1. Presence of cardiac pain
2. Medications taken before hospitalization
3. Presence of jugular vein distention
4. Heart sounds and apical rate
5. Presence of diaphoresis
6. History of difficulty breathing

Answer 43

1, 3, 4, 5
A focused cardiac assessment is directed toward assessing physiologic symptoms (cardiac pain, JVD distention, heart sounds and rate, presence of diaphoresis) that provide immediate information regarding the client’s condition, which is appropriate for the nurse to do at the beginning of each shift. After the physiologic parameters have been evaluated, the nurse can determine any history of difficulty breathing and a list of medications the client was taking before admission.
(Illustrated, p 397)

Question 44

During the night, a client with a diagnosis of acute coronary syndrome (myocardial infarction) is found to be restless and diaphoretic. What is the best nursing action?

1. Check is temperature and determine his serum blood level
2. Turn the alarms low and promote sleep by decreasing the number of interruptions
3. Check the monitor to determine his cardiac rhythm and evaluate vital signs
4. Call the physician to obtain an order for sedation

Answer 44

3
Restlessness and diaphoresis may be indicative of decreased cardiac output, frequently originating from a dysrhythmia. Checking temperature and blood glucose levels is not a priority. Turning the alarm sound to low and reducing interruptions to facilitate sleep will be done when all physical problems are resolved. Physiologic needs must be addressed first. It is important to obtain critical assessment data before calling the doctor.
(Illustrated, p 397)

Question 45

The nurse is taking the history of a client with heart failure caused by chronic hypertension. The nurse identifies what data as supportive of the client’s medical diagnosis?

1. Dyspnea after walking about half a block
2. Weight loss of 15 pounds over last 3 months
3. Lower extremity edema in the evenings
4. Dizziness and fainting when rising too quickly

Answer 45

1
Dyspnea on exertion is a classic sign of left ventricular problems, regardless of the precipitating cause. Lower extremity edema is also characteristic, but is not as significant as dyspnea on exertion. Dizziness and fainting on standing are indicative of postural (orthostatic) hypotension.
(Illustrated, p 398)

Question 46

A client is admitted with mitral valve disease and left ventricular dysfunction. What is the most reliable test to determine cardiac status?

1. Electrocardiogram
2. Stress test
3. Cardiac angiogram
4. Echocardiogram

Answer 46

4
An echocardiogram provides information regarding flow of blood through the mitral valve and left ventricular performance. An angiogram is done to determine coronary artery blood flow. A stress test is done to evaluate exercise tolerance. An ECG is done to evaluate cardiac conduction.

(Illustrated, p 398)

Question 47

What would be an important home care goal for a client who has infective endocarditis?

1. To begin an exercise regimen as soon as possible
2. To monitor urinary output
3. To continue antibiotic therapy
4. To decrease activity until pulse stabilizes

Answer 47

3
Antibiotics (usually administered by IVPB) are indicated for infective endocarditis. This may continue at home with the assistance of a home care nurse to administer the IVPBs, or the client may not be changed to oral antibiotics. The continued antibiotic is critical to the prevention of vegetation growth on the valves. The options are not specific to or a priority goal for managing a client with infective endocarditis.

(Illustrated, p 398)

Question 48

Superior Vena Cava Syndrome (bonus question)

Answer 48

Patients frequently report mild dyspnea, nonproductive cough, a sense of “fullness” in the head, chest pain. Patients often notice increased symptoms in the morning after sleeping in a supine position or with position changes such as bending forward, coughing, or stooping. Patients may experience facial, neck, or arm swelling upon arising in the morning, causing shirt collars to become tight (Stoke sign)