MED/SURG EXAM #1

Question 1

Differentiate the anatomic location and function of the following structures of the heart: pericardial layers, atria, ventricles, and valves.
_______________
Objective #1

Answer 1

Pericardial layers:
Atria layers:
Ventricles:
Valves:

Question 2

Stages of development in atherosclerosis

Answer 2

Chronic endothelial injury which leads to…
1) Fatty streak
2) Fibrous plaque
3) Complicated lesion

NOTE: when the patient becomes symptomatic, the disease process usually is well advanced

Question 3

Relate the coronary circulation to the areas of heart muscle supplied by the major coronary arteries.
_____________
Objective #2

Question 4

Differentiate the structure and function of arteries, veins, capillaries, and endothelium.
__________
Objective #3

Question 5

Describe the mechanism involved in the regulation of blood pressure
_________
Objective #4

Question 6

Relate the various waveforms on a normal electrocardiogram to the associated cardiac events
_________
Objective #5

Question 7

Obtain significant subjective and objective assessment data related to the cardiovascular system from a patient and/or caregiver
________
Objective #6

Question 8

Perform a physical assessment of the cardiovascular system using the appropriate techniques
___________
Objective #7

Question 9

Differentiate normal from abnormal finding s of a physical assessment of the cardiovascular system
_______
Objective #8

Question 10

Link the age-related changes of the cardiovascular system to the differences in assessment findings
________
Objective #9

Question 11

Describe the purpose, significance of results, and nursing responsibilities related to diagnostic studies of the cardiovascular system
________
Objective #10

Question 12

11. Relate the pathophysiologic mechanisms associated with primary hypertension to the clinical manifestations and complications

Question 13

12. Select appropriate strategies for the prevention of primary hypertension

Question 14

13. Describe the interprofessional care for primary hypertension, including drug therapy and lifestyle modification.

Question 15

14. Explain the interprofessional care of the older adult with primary hypertension.

Question 16

15. Prioritize the nursing management of the patient with primary hypertension

Question 17

16. Describe the nursing and interprofessional care of a patient with a hypertensive crisis.

Question 18

17. Relate the etiology and pathophysiology of coronary artery disease (CAD) and acute coronary syndrome (ACS) to the clinical manifestations of each disorder.

Question 19

18. Describe the nursing role in the promotion of therapeutic lifestyle changes in patients at risk for CAD

Question 20

19. Differentiate the precipitating factors, clinical manifestations, interprofessional care, and nursing management of the patient with CAD and chronic stable angina

Question 21

20. Explain the clinical manifestations, diagnostic studies, complications, and interprofessional care of the patient with ACS

Question 22

21. Evaluate commonly used drug therapy in treating patients with CAD and ACS

Question 23

22. Prioritize key components to include in the rehabilitation of patients recovering from ACS and coronary revascularization procedures

Question 24

23. Differentiate the precipitating factors, clinical presentation, and interprofessional care of patients who are at risk for or have experienced sudden cardiac death.

Question 25

24. Compare the pathophysiology of systolic and diastolic heart failure (HF).

Question 26

25. Relate the compensatory mechanisms involved in HF to the development of acute decompensated heart failure (ADHF) and chronic HF.

Question 27

26. Select appropriate nursing and interprofessional care to manage the patient with ADHF.

Question 28

27. Select appropriate nursing and interprofessional care to manage the patient with HF.

Question 29

28. Describe the indications for heart transplantation and the nursing care of transplant recipients.

Question 30

**Verapamil:** Class Adverse effects What to monitor?

Answer 30

Class: Calcium Channel Blockers (CCB) Adverse effects: atrial fibrillation What to monitor?: **NO GRAPEFRUIT JUICE**

Question 31

**HCTZ:** Class Adverse effects: What to monitor?

Answer 31

Class: *Thiazides (ends in -ides)* Adverse effects: Orthostatic hypotension, hypovolemia, HYPONa, HYPERglycemia What to monitor?: decrease in K+ (leg cramps, fatigue, tachycardia), K+-rich foods (dark leafy greens)

Question 32

**Beta Adrenergic Blockers** Class Adverse effects What to monitor?

Answer 32

Class: Adverse effects: masked HYPOglycemia effects *(e.g. Metoprolol);* Bradycardia What to monitor?:

Question 33

Teaching for a patient newly Dx’d with heart failure

Answer 33

— exercise — watch changes in sleep patterns — Check fluid volume for overload (HYPONa+ & NSAIDS can cause weight gain)

Question 34

Purpose of taking Warfarin + what to monitor? + Antidote?

Answer 34

*Prevent blood clots (anticoagulants)* — Labs: PT, INR **Antidote = Vitamin K**

Question 35

Purpose of taking Heparin + what to monitor? + Antidote?

Answer 35

Purpose: does NOT dissolve the clot, but prevents — Labs: PTT **Antidote = Protamine Sulfate**

Question 36

Identify Iron (Fe) rich foods

Answer 36

— Nuts — Dried fruits: apricots, raisins — Legumes: lentils, mixed/baked beans, chickpeas — Dark leafy greens: spinach, silver beet, broccoli — Oats — Tofu — Fortified cereals, breads and pastas — Red meat, pork, poultry — Peas

Question 37

How to read an ECG + determine interval durations

Answer 37

P-wave: atrial depolarization PR segment: QRS complex: ST segment: T-wave:

Question 38

Troponins + difference b/w L/R-sided heart failure

Question 39

Difference in a pacemaker when spiked at the Q/P

Answer 39

— When spiked @ the Q —> V-paced (ventricular) — When spiked @ *before* the P-wave —> A-paced (atrial)

Question 40

The purpose of determining capillary refill?

Answer 40

To determine arterial sufficiency

Question 41

What are the shockable rhythms?

Answer 41

— Pulseless VTach — VFIB

Question 42

ABCs related to Cardiovascular

Question 43

What is the proper treatment for the S/Sx’s of severe bradycardia?

Answer 43

ATROPINE Dosage:

Question 44

Interventions/Teaching when taking Nitroglycerine (NTG)

Answer 44

1 dose, wait 5 minutes. If doesn’t work, do another dose Max dose: 3 within a 15 minute time period; If that doesn’t work, GO TO THE HOSPITAL!! —If a patch, make sure to place on in the AM, and take OFF at night/bedtime (stays on for no more than 12-14 hours)

Question 45

Teaching when taking Digoxin

Answer 45

**DO NOT TAKE IF HR <60bpm** — HYPOkalemia — Increase risk for Digoxin toxicity (**0.8-2**)

Question 46

MEDS TO STUDY: Heparin, Lisinopril, Warfarin, NTG, Digoxin, Dobutamin, ASA, Atenolol, Aloe Vera

Question 47

Herbals that impact someone with CAD

Answer 47

— Feverfew: — Aloe vera — Flax seed

Question 48

Right-sided heart failure vs. Left-sided heart failure

Answer 48

RSHF: LSHF:

Question 49

Non-modifiable risk factors of coronary artery disease (CAD)

Answer 49

— age — gender: 45+ for men, 55+ for women (highest incidence among white middle-aged men) — ethnicity (women are more likely to die after 1st MI, but is most prevalent in black women) — genetics: predisposed = key factor

Question 50

Modifiable risks factors of coronary artery disease

Answer 50

_LIPIDS:_ — cholesterol >200mg/dL — triglycerides >150mg/dL — LDL cholesterol >130mg/dL (think: “lethal”; low down dirty shame) — HDL cholesterol <40mg/dL (men), <50mg/dL (women) (think: “healthy”) — DM — Tobacco use — Physical inactivity — Obesity: weight circumference >102cm or >40 in (men), >88cm/>35in (women) — Psychosocial risk factors (e.g. depression, hostility) — HIGH homocysteine levels — Substance abuse

Question 51

Stage differences with hypertension

Answer 51

**Normal:** <120/80 **PreHTN:** 120-139/80-89 **Stage 1:** 140-159/90-99 **Stage 2:**>160/>100

Question 52

Differences between systolic vs. diastolic pressure

Answer 52

**Systolic (top #):** pressure when the heart contracts blood to pump to the rest of the body **Diastolic (bottom #):** pressure when the heart relaxes b/w beats

Question 53

Amount of protein needed for someone with cardiac conditions

Answer 53

— 5-6oz/day

Question 54

NG Question about difference between STABLE vs UNSTABLE angina

Question 55

Differences between NSTEM vs. STEMI on the EKG