Week 4- Cardio EAQs Flashcards
The nurse identifies that a patient is in the initial stage of Raynaud’s disorder. Which assessment finding is consistent with the early stage of this condition?
Throbbing, tingling, and swelling of the limbs
Chronic ischemic pain and ulcers on both feet
Color changes of fingers from white to blue to red
Hypertension, hyperglycemia, and inflamed arteries
Color changes of fingers from white to blue to red
The vasospasm-induced color changes (from white to blue to red) of fingers, toes, ears, and nose are the usual characteristics of Raynaud’s disorder. Decreased perfusion leads to pallor (white), followed by cyanotic (bluish purple) digits that further turn red when blood flow is restored. In the later phases of the disease, the patient may complain about numbness and coldness along with throbbing, tingling, and swelling. Chronic ischemic pain and ulceration may indicate peripheral arterial disease, whereas hypertension, hyperglycemia, and inflamed arteries may indicate one or more cardiovascular disorders.
A patient with hypertension receives a prescription for lisinopril. Which mechanism of action would the nurse expect from this medication?
Blocks α-adrenergic effects
Relaxes arterial and venous smooth muscle
Inhibits conversion of angiotensin I to angiotensin II
Reduces sympathetic outflow from the central nervous system (CNS)
Inhibits conversion of angiotensin I to angiotensin II
Lisinopril is an angiotensin-converting enzyme (ACE) inhibitor that inhibits the conversion of angiotensin I to angiotensin II, which reduces angiotensin II–mediated vasoconstriction and sodium and water retention. β-Adrenergic receptor blockers (β-blockers) block β1-adrenergic receptors and result in vasodilation and a decreased heart rate. Direct vasodilators relax arterial and venous smooth muscle. Central-acting α-adrenergic antagonists reduce sympathetic outflow from the CNS to produce vasodilation and decreased systemic vascular resistance (SVR) and BP.
As treatment for hypertensive crisis, a patient has received sodium nitroprusside for 3 days. For which reason would the nurse plan to monitor the patient’s thiocyanate levels?
The medication has a long half-life.
The medication is metabolized to cyanide and then thiocyanate.
An increased level indicates interactions with other drugs the patient is taking.
An increased level indicates adverse effects on target organs caused by the medication.
The medication is metabolized to cyanide and then thiocyanate.
Sodium nitroprusside causes arterial vasodilation and reduces systemic vascular resistance. This, in turn, decreases the BP. Sodium nitroprusside is metabolized to cyanide and then to thiocyanate, which can reach lethal levels. Therefore thiocyanate levels should be monitored in patients receiving the drug for more than 3 days or at doses greater than or equal to 4 mcg/kg/min. The cause of concern and the need to assess the thiocyanate level do not relate to the medication’s half-life. An increased level does not indicate adverse effects on target organs. It does not indicate interactions with other medications.
The nurse reviews the treatments for lower extremity peripheral artery disease (PAD). Which therapy involves percutaneous transluminal angioplasty (PTA) and cold therapy?
Stent
Cryoplasty
Atherectomy
Endothelial progenitor cell therapy
Cryoplasty
Cryoplasty involves percutaneous transluminal angioplasty and cold therapy that use a specialized balloon filled with liquid nitrous oxide. Expansion of gas causes cooling that prevents restenosis. A stent is an expandable metallic device that helps keep an artery open. Atherectomy is the process of removing obstructing plaque. Endothelial progenitor cell therapy is used to stimulate blood vessel growth.
At which rate must blood flow in the brain be maintained for normal functioning?
200 to 400 mL/min
400 to 600 mL/min
650 to 750 mL/min
750 to 1000 mL/min
750 to 1000 mL/min
Blood flow must be maintained at 750 to 1000 mL/min (55 mL/100 g of brain tissue), or 20% of the cardiac output, for optimal brain functioning. Anything below that level, neurologic metabolism is altered.
The nurse reviews the care options for patients with lower extremity peripheral artery disease (PAD). Which treatment is used to stimulate blood vessel growth?
Urokinase
Stem cell therapy
Plasminogen activator
Spinal cord stimulation
Stem cell therapy
Stem cell therapy is used to stimulate blood vessel growth, or angiogenesis. Urokinase is recommended to reduce complications associated with a thrombectomy. Plasminogen activator is used if surgical thrombectomy is not recommended. Spinal cord stimulation is helpful to control pain and prevent amputation.
Which term is used to describe difficulty breathing when lying down?
Dyspnea
Orthopnea
Bradypnea
Paroxysmal nocturnal dyspnea (PND)
Orthopnea
___________ is the term for abnormally slow breathing
Bradypnea
Which lobe of the brain is affected if a patient has Broca aphasia?
Frontal lobe
Parietal lobe
Occipital lobe
Temporal lobe
Frontal lobe
A patient is diagnosed with peripheral artery disease (PAD). The nurse anticipates that which medication will be prescribed?
Sildenafil
Bosentan
Cilostazol
Simvastatin
Simvastatin
Lipid management is essential in the patient with PAD. Statins such as simvastatin lower the low-density lipoprotein (LDL) and triglyceride levels and are used to treat peripheral arterial disease. Sildenafil is used to treat Buerger disease. Bosentan is used as an endothelin receptor antagonist in patients with Raynaud’s phenomenon. Cilostazol is also used to treat Buerger disease.
The nurse is preparing to measure the blood pressure (BP) of a patient who is lying down on a bed. Which technique should the nurse use?
Place the BP cuff on the forearm when measuring the BP.
Measure the BP in both arms and record the lowest reading.
Rest the patient’s arm on a pillow during the BP measurement.
Measure the BP twice in quick succession and average the readings.
Rest the patient’s arm on a pillow during the BP measurement.
Which ethnic group has the highest incidence of stroke?
Asians
Mexicans
Caucasians
Blacks
Blacks
Blacks have twice the incidence of stroke and a higher death rate from stroke compared to any other ethnic group. This may be related in part to a higher incidence of hypertension, obesity, and diabetes. Asians, Mexicans, and Caucasians have a lower risk of stroke than do Blacks.
Normal BP is
under 120/80
Elevated BP is
120-129
Under 80
HTN stage 1
Stage 2
Stage 1 - 130-139 / 80-89
Stage 2- Over 140/90
Which assessment would the nurse teach a patient to report as part of the warning signs of stroke, using the mnemonic FAST?
Footdrop
Arm strength
Orientation
Facial drooping
Facial drooping
The FAST mnemonic, a quick and easy way to remember the signs of stroke according to the American Stroke Association, includes Face drooping, Arm weakness, Speech difficulties, and Time. Footdrop, arm strength, and orientation are not specific to the FAST mnemonic.
Which intervention would the nurse include in the plan of care for a patient diagnosed with peripheral arterial disease?
Soak patient’s feet daily.
Place pillow under calves.
Apply compression stockings.
Apply wet-to-dry dressings on any foot ulcer.
Place pillow under calves.
Placing pillows under the patient’s calves will keep the heels off the bed and will reduce pressure that may cause ulceration. Other interventions include keeping the patient’s feet clean and dry; do not soak feet to prevent maceration. Footwear should be lightweight and roomy; do not use compression stockings. Cover ulcers with a dry, sterile dressing.
Which rationale would explain why a patient is not responding well to clopidogrel therapy?
The patient eats low-sodium food.
The patient has peripheral artery disease.
The patient takes omeprazole medication.
The patient experiences aspirin intolerance.
The patient takes omeprazole medication.
Omeprazole interacts with clopidogrel and reduces the therapeutic action of clopidogrel by half. Therefore clopidogrel should not be administered with omeprazole. Clopidogrel is an antiplatelet drug and is used to treat peripheral artery disease. Low-sodium food will help maintain blood pressure in peripheral artery disease. Clopidogrel is recommended for peripheral artery disease. Clopidogrel is recommended for the patient who has aspirin intolerance.
Which finding is consistent with a left-hemispheric stroke?
Impaired judgment
Unilateral weakness of the left extremities
Unilateral weakness of the right extremities
Spatial-perceptual deficits
Unilateral weakness of the right extremities
Which information will a transcranial doppler (TCD) ultrasonography provide?
It measures the velocity of blood flow in the cerebral arteries.
It identifies red blood cells in the cerebrospinal fluid.
It visualizes cerebral blood vessels.
It measures brain oxygenation.
It measures the velocity of blood flow in the cerebral arteries.
Which assessment finding is consistent with right-sided heart failure (HF)?
Jugular venous distention (JVD)
Presence of S3 and S4 heart sounds
Paroxysmal nocturnal dyspnea (PND)
Displacement of the point of maximal impulse (PMI)
Jugular venous distention (JVD)
Which instruction is important for the nurse to provide to a patient about the management of stage 1 hypertension?
Restrict all caffeine.
Restrict sodium intake.
Increase protein intake.
Use calcium supplements.
Restrict sodium intake.
For the patient receiving intraaortic balloon pump (IABP) therapy, on which part of the electrocardiogram (ECG) would the nurse expect the balloon inflation?
P wave
Q wave
R wave
T wave
T wave
The nurse provides discharge teaching to a female patient who was newly diagnosed with primary hypertension. Which instruction would be included?
Decrease the intake of omega-3 fatty acids.
Restrict sodium to less than or equal to 2300 mg/day.
Limit the intake of alcohol to no more than one drink per day.
Begin taking a calcium supplement to help lower blood pressure (BP).
Limit the intake of alcohol to no more than one drink per day.
Excessive alcohol intake is strongly associated with hypertension. Women and lighter-weight men should limit their intake to no more than one drink per day. Increased levels of dietary omega-3 fatty acids are associated with lower BP. People with hypertension should restrict sodium to less than or equal to 1500 mg/day. Calcium supplements are not recommended to lower BP.
People with HTN should restrict sodium to less than or equal to _______ mg/day
1500
For the patient experiencing cardiogenic shock after an acute myocardial infarction, which rationale would the nurse associate with use of intraaortic balloon pump (IABP) therapy?
Reduces coronary artery vessel perfusion
Reduces pressure in the pulmonary artery
Enhances the effectiveness of cardiac medications
Provides time to perform an emergency angiogram
Provides time to perform an emergency angiogram
To ensure the safety of the patient with an implanted ventricular assist device (VAD) being prepared for discharge, of which intervention would the nurse verify completion prior to the patient leaving the hospital?
Home care referral initiated
Diet and activity teaching completed
Battery charger available in the home
Oxygen condenser delivered to the home
Battery charger available in the home
The nurse suspects that which drug being used to treat chronic heart failure is the cause of the male patient’s enlarged breasts?
Digoxin
Captopril
Carvedilol
Spironolactone
Spironolactone
Which physiologic change occurs when epinephrine and norepinephrine are released in response to decreased cardiac output in a patient with heart failure (HF)?
Vasodilation
Decreased heart rate
Decreased blood pressure (BP)
Increased oxygen demand
Increased oxygen demand
A patient is diagnosed with primary hypertension and asks the nurse what caused the condition. Which response would the nurse give?
“There is no identified cause.”
“A decrease in plasma renin levels.”
“Too much plaque in the blood vessels.”
“Kidney disease is the most common cause.”
“There is no identified cause.”
Primary hypertension does not have an identifiable cause. There is not one exact cause of primary hypertension; there are several contributing factors. An increase, not a decrease, in plasma renin levels is a contributing factor in the development of primary hypertension. Hypertension speeds up the process of atherosclerosis in the peripheral blood vessels. Renal or kidney disease is a cause of secondary hypertension.
The nurse reviews the assessment findings of a patient with atherosclerosis and notes an ankle-brachial index (ABI) of 0.8, decreased Doppler pressures, aspirin intolerance, and arterial stenosis. Which treatment would likely be prescribed for this patient?
Nifedipine
Clopidogrel
Furosemide
Doxycycline
Clopidogrel
The patient’s symptoms suggest peripheral artery disease (PAD), which is treated with antiplatelet drugs. Because the patient has aspirin intolerance, clopidogrel would be beneficial. Nifedipine is a calcium channel blocker used to reduce the severity of a vasospastic attack. Furosemide is a diuretic and is used to treat hypertension. Doxycycline is used to treat aortic aneurysms.
A patient reports a recent onset of pain in the calf when climbing stairs. The pain is relieved when the patient sits and rests for about 2 minutes. Which condition would the nurse suspect?
Muscle cramping
Venous insufficiency
Intermittent claudication
Sore muscles from overexertion
Intermittent claudication
