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
Which artery would be obstructed if a patient sustained a stroke and is experiencing cranial nerve deficits?
Vertebral artery
Middle cerebral artery
Anterior cerebral artery
Posterior cerebral artery
Vertebral artery
Which respiratory rate would the nurse anticipate in a patient who is developing pulmonary edema?
6 to 8 breaths/min
10 to 14 breaths/min
16 to 20 breaths/min
32 to 36 breaths/min
32 to 36 breaths/min
A patient who underwent percutaneous transluminal angioplasty (PTA) to treat lower leg peripheral artery disease is prescribed a low dose of aspirin daily. Which action is the desired effect of this medication?
To prevent platelet agglutination
To stimulate collateral circulation
To decrease liver production of vitamin K
To control pain resulting from the procedure
To prevent platelet agglutination
A patient’s blood pressure (BP) reading is 142/91 mm Hg. How would the nurse classify the BP?
Normal
Prehypertension
Hypertension, stage 1
Hypertension, stage 2
Hypertension, stage 2
The nurse is teaching an older patient with hypertension about developing an exercise program. Which instructions would the nurse include?
Perform balance exercises daily.
Perform flexibility exercises twice each day.
Perform muscle-strengthening activities twice a week.
Perform high-intensity activity for 30 minutes on most days.
Perform muscle-strengthening activities twice a week.
Which treatment may help prevent amputation in patients with critical limb ischemia?
Nifedipine
Pseudoephedrine
Spinal cord stimulation
Oxygen via nasal cannula
Spinal cord stimulation
In which part of the body would the nurse expect to find edema in a patient with heart failure (HF) who spends the majority of the time lying in bed?
Feet
Face
Sacrum
Abdomen
Sacrum
The nurse would monitor for which side effect in a patient who takes an angiotensin-converting enzyme (ACE) inhibitor to treat chronic heart failure (HF)?
Cough
Anemia
Hyperpigmentation
Increased body temperature
Cough
A male Hispanic patient is diagnosed with peripheral artery disease (PAD). The patient’s health history includes smoking and depression. Which risk factor does this patient have for PAD?
Gender
Tobacco
Ethnicity
Comorbidity
Tobacco
Which effect would be expected from a cardiac medication that is a positive chronotropic agent?
Increased heart rate
Increased stroke volume
Increased cardiac output
Increased myocardial contractility
Increased heart rate
Which changes in vital signs indicate that a patient who has just stood up is experiencing postural hypotension?
Increased systolic blood pressure (BP) and/or decreased heart rate (HR)
Increased diastolic BP and/or decreased HR
Decreased systolic BP, decreased diastolic BP, and/or increased HR
Decreased systolic BP, increased diastolic BP, and no change in HR
Decreased systolic BP, decreased diastolic BP, and/or increased HR
Which medication would likely be prescribed to a patient who has intermittent claudication?
Ramipril
Warfarin
Simvastatin
Pentoxifylline
Pentoxifylline
Which type of drug therapy is used to treat volume overload in patients with acute decompensated heart failure (ADHF)?
Diuretics
Narcotics
Vasodilators
Positive inotropes
Diuretics
Which compensatory mechanism of heart failure (HF) results in increased heart rate and ventricular contractility?
Ventricular remodeling
Dilation
Hypertrophy
Sympathetic nervous system (SNS) activation
Sympathetic nervous system (SNS) activation
Which diagnostic study is the most reliable to identify the source of a subarachnoid hemorrhage?
Cardiac imaging
Cerebral angiography
Magnetic resonance angiography
CT angiography
Cerebral angiography
Which rationale supports gene and stem cell therapy for a patient who has critical limb ischemia?
Reduces pain
Increases perfusion
Prevents maceration
Promotes angiogenesis
Promotes angiogenesis
Which information would the nurse teach to a patient who has a new prescription for doxazosin?
“Monitor yourself for a fast heart rate, which is a common side effect.”
“Make position changes slowly, especially from lying down to standing.”
“The medication also improves breathing by decreasing chest congestion.”
“It is common for patients who take this medication to experience nausea.”
“Make position changes slowly, especially from lying down to standing.”
Which medication should be used with caution in patients with diabetes because the drug may depress the tachycardia associated with hypoglycemia?
Diltiazem
Metoprolol
Prednisone
Hydromorphone
Metoprolol
Which clinical manifestation would the nurse expect in a patient with paroxysmal nocturnal dyspnea (PND)?
Decreased attention span
Breathlessness on exertion
Awakening with a feeling of suffocation
A nonproductive cough that is worse when lying down
Awakening with a feeling of suffocation
A patient reports fingers and toes that change color from pallor to cyanosis to rubor when exposed to cold temperatures. The patient states that, after the color changes, the digits are throbbing, achy, and tingly. Which condition would the nurse suspect?
Aortic aneurysm
Raynaud’s phenomenon
Post-thrombotic syndrome
Superficial vein thrombosis
Raynaud’s phenomenon
The nurse would monitor for which major side effect in a patient who takes an angiotensin-converting enzyme (ACE) inhibitor for treatment of chronic heart failure?
Angioedema
Hypokalemia
Inability to swallow
Symptomatic hypertension
Angioedema
an allergic reaction involving edema of the face and airways.
A patient with intermittent claudication experiences pain in the leg muscles while exercising that resolves within 10 minutes after stopping. Which substance building up in the leg is causing the ischemic pain?
Lactic acid
Triglycerides
Homocysteine
Blood viscosity
Lactic acid
Which term would the nurse chart in the patient’s medical record if the patient is unable to recognize familiar objects after a stroke?
Alexia
Agnosia
Aphasia
Agraphia
Agnosia
How quickly does cellular death occur if blood flow to the brain is interrupted?
30 seconds
2 minutes
5 minutes
30 minutes
5 minutes
An increase in _________ is one of the causes of resistant hypertension
obesity
For which condition is dopamine prescribed in a patient with heart failure (HF)?
Hypotension
Acute anxiety
Peripheral edema
Paroxysmal nocturnal dyspnea (PND)
Hypotension
Which type of stroke correlates with the clinical manifestations of a severe headache, hypertension, vomiting, dysarthria, and eye movement disturbances?
Embolic stroke
Thrombotic stroke
Intracerebral hemorrhage
Subarachnoid hemorrhage
Intracerebral hemorrhage
Symptoms such as headaches, high blood pressure, vomiting, dysarthria, and eye movement disturbances indicate intracerebral hemorrhage. An embolic stroke is mostly related to heart conditions such as atrial fibrillation, myocardial infarction, and infective endocarditis. A thrombotic stroke has the clinical manifestation of decreased level of consciousness in the first 24 hours. Clinical manifestations such as stiff neck and cranial nerve deficits indicate a subarachnoid hemorrhage.
Which clinical manifestation is associated with a stroke on the right side of the brain?
Impulsiveness
Impaired speech
Slow performance
Paralyzed right side
Impulsiveness
A patient who sustains a stroke on the right side of the brain shows impulsiveness.
Impaired speech, slow performance, and a paralyzed right side occur when a patient has had a stroke on the left side of the brain.
The nurse is assessing a patient for orthostatic hypotension. First, the nurse measured the blood pressure (BP) and heart rate (HR) with the patient in the supine position. Which action would the nurse take next?
Repeat BP and HR every 15 minutes in the supine position.
Ask the patient to stand, and then measure the BP and HR within 15 minutes.
Move the patient to a standing position and immediately measure the BP and HR.
Move the patient to a sitting position and measure the BP and HR within 2 minutes.
Move the patient to a sitting position and measure the BP and HR within 2 minutes.
Which condition would the nurse check for in the patient’s history before administering cilostazol?
Heart failure
Diabetes mellitus
Buerger disease
Intermittent claudication
Heart failure
A patient who has been taking clonidine for 10 years tells the nurse, “I decided to quit taking the medication a few days ago.” For which manifestation would the nurse monitor this patient?
Tremors
Lethargy
Dysphasia
Bradycardia
Tremors
Which condition causes the symptoms of right-sided heart failure?
Decreased preload
Increased cardiac output
Fluid congestion in the lungs
Systemic venous congestion
Systemic venous congestion
Right-sided heart failure (HF) occurs when the ________________ does not pump effectively.
right ventricle (RV)
Which food would be included in the diet for a patient who had a stroke and has dysphagia?
Milkshakes
Chicken soup
Mashed potatoes
Pureed cooked rice
Mashed potatoes
Patients who had a stroke and have dysphagia have difficulty chewing and swallowing. Thus the nurse would include mashed potatoes because the food is easy to swallow and provides enough texture. Milkshakes and all milk products should be avoided because they increase the viscosity of mucus, which leads to an increase in salivation. Chicken soup is a thin liquid that may be difficult to swallow and could trigger coughing or choking. Pureed cooked rice is bland to the taste and may stick to the palate, which poses a risk for aspiration.
The nurse provides education to a group of women about preventing hypertension. Which information would the nurse include? Select all that apply. One, some, or all responses may be correct.
Lose weight.
Limit nuts and seeds.
Limit sodium and fat intake.
Drink fat-free or low-fat milk.
Perform moderate physical activity for at least 30 minutes on most days.
Limit sodium and fat intake.
Drink fat-free or low-fat milk.
Perform moderate physical activity for at least 30 minutes on most days.
The nurse expects which assessment finding in a patient with chronic heart failure (HF)?
Cough that is worse upon awakening
Bradycardia
Flushed skin
Sleep apnea
Sleep apnea
Snoring and daytime sleepiness can indicate sleep ________ , a common condition with chronic HF.
apnea
Which behavior would be exhibited by a patient who has suffered a right-brain stroke?
Very cautious
Difficulty with words
Impulsive and impatient
Accomplishes tasks quickly
Impulsive and impatient
Which noninvasive test is used to diagnose heart failure (HF)?
Chest x-ray
Echocardiogram
Cardiac catheterization
Electrocardiogram (ECG)
Echocardiogram
The nurse would monitor for which condition in a patient with left-sided heart failure?
Pedal edema
Hepatomegaly
Splenomegaly
Pulmonary congestion
Pulmonary congestion
When the left ventricle (LV) fails, blood backs up into the left atrium (LA). This causes fluid accumulation in the _______
lungs
A patient has been prescribed atenolol. Which condition would the nurse question the patient about before administering the drug?
Asthma
Dry cough
Depression
Diabetes
Diabetes
Atenolol is a cardioselective β1-blocker that reduces blood pressure (BP) by blocking β-adrenergic effects. It should be used with caution in patients with diabetes because it depresses the tachycardia associated with hypoglycemia and may hinder diagnosing hypoglycemia. A history of asthma, dry cough, or depression does not affect the administration of the drug. Noncardioselective β-adrenergic receptor blockers (β-blockers) should not be used in patients with asthma because of the risk of bronchospasm, but this is not the case with atenolol because it is cardioselective. Angiotensin-converting enzymes may cause a dry cough.
When feeding a patient with a stroke on the left side, in which position would the nurse place the patient?
Right lateral position
Low-Fowler position
High-Fowler position
Trendelenburg position
High-Fowler position
Which rationale explains the use of ramipril in a patient with symptomatic peripheral artery disease (PAD)?
Reduces hypertension
Reduces vasospastic attack
Slows growth rate of aneurysm
Lowers low-density lipoproteins
Reduces hypertension
Ramipril is an angiotensin-converting enzyme (ACE) inhibitor. It reduces hypertension by inhibiting the production of _______________
angiotensin II.
Which condition may a patient have experienced if the patient was exhibiting symptoms of a stroke for 45 minutes before the symptoms resolved?
Embolic brain stroke
Acute brain infarction
Transient ischemic attack
Subarachnoid hemorrhage
Transient ischemic attack
A transient ischemic attack is a transient episode of neurologic symptoms without acute brain infarction. Symptoms typically last less than 1 hour.
The nurse correlates which condition with the assessment findings of a patient with acute decompensated heart failure (ADHF) who experiences blood-tinged sputum, a productive frothy cough, and tachycardia?
Cerebral edema
Peripheral edema
Lymphatic edema
Pulmonary edema
Pulmonary edema
_____ can manifest as pulmonary edema, which is an acute, life-threatening condition
ADHF
