n1220 wk 4 perfusion (with practice eaq questions)
Chronic Stable Angina (CSA) Pectoris
-"Strangling of the chest" -Temporary imbalance between coronary artery's ability to supply oxygen and cardiac muscle's demand for oxygen Interventions -nitroglycerin -rest
Perfusion
-Perfusion refers to the flow of blood through arteries and capillaries delivering nutrients and oxygen to cells. -Potential for decreased perfusion due to inadequate cardiac output -Potential for pulmonary edema due to left-sided heart failure Risk Factors for Impaired Perfusion/ heart disease Modifiable - Smoking - Serum Lipid level - Sedentary lifestyle - Obesity - Diabetes mellitus, Hypertension Unmodifiable - Age - Gender - Genetic Diagnostic Testing - Laboratory tests - Electrocardiogram (ECG) - Cardiac stress tests - Radiographic studies Consequences -Decrease cardiac output -Shock -Occlusion -Constriction -Dilation Prevention/Patient Education - Smoking and nicotine cessation - Diet - Exercise - Weight control - Screenings (BP, serum lipid level) Interventions Treatment strategies depend on underlying condition The most common strategies include: - Diet modification and smoking cessation - Increased activity (conditioning) Pharmacotherapy Management Reduce afterload - Angiotensin-converting enzyme inhibitors - Angiotensin-receptor blockers Reduce preload - Diuretics - Vasodilators Enhance contractility - Cardiac glycoside - Beta-adrenergic blockers Procedures and Surgical Interventions - Defibrillation -Pacemaker insertion -Cardiac valve surgery -Cardiac transplant -Bypass and/or graft surgery -Stent or angioplasty -Endarterectomy
Which assessment finding does the nurse expect when caring for a patient who is hospitalized with sustained tachydysrhythmia? 1 Fainting 2 Flushing 3 Agitation 4 Bounding pulse
1
Which clinical term describes a piece of a clot that travels from a deep leg vein and lodges in the pulmonary vein? 1 Embolus 2 Thrombus 3 Thrombophlebitis 4 Peripheral vascular disease
1
Which enzyme acts on angiotensinogen to split off angiotensin I as part of a blood pressure (BP) control system? 1 Renin 2 Sodium 3 Aldosterone 4 Angiotensin-converting enzyme
1
Which principle related to angina pain is important for the nurse to remember? 1 The administration of nitroglycerin (NTG) will improve oxygen supply. 2 There will be an ST elevation noted on the ECG. 3 The patient will have an increase in body temperature. 4 Premature ventricular contractions (PVCs) accompany the pain
1
Which procedure is associated with a patient developing ICU psychosis? 1 Mechanical ventilation 2 Cardiac catheterization 3 Electrophysiological study (EPS) 4 Intravascular ultrasonography
1
Which type of hypertension is the most common? 1 Essential 2 Malignant 3 Secondary 4 Gestational
1
Which purpose does the DASH diet have? 1 Stopping hypertension 2 Stopping heart disease 3 Stopping use of dietary salt 4 Stopping consumption of red meats
1 DASH stands for "dietary approaches to stop hypertension.
Which is an objective of the Healthy People 2020 initiative to reduce hospitalization of older adults with heart failure as the principal diagnosis? Select all that apply. One, some, or all responses may be correct. 1 Ensure that the interprofessional team provides follow-up care in the home or nursing home. 2 Call the hospitalized patient to assess signs or symptoms of impending heart failure. 3 Provide a continuing plan of care for the patient and family or other caregivers when the patient is discharged from the hospital. 4 For patients hospitalized for heart failure, collaborate with the case manager for discharge planning, including adequate support in the community. 5 Teach the patient and family or other caregiver about when to call the health care provider for health changes so that the patient can be treated at home.
1, 3, 4, 5
Which factor increases a patient's risk for a venous thromboembolism (VTE)? Select all that apply. One, some, or all responses may be correct. 1 Obesity 2 Malnutrition 3 Advancing age 4 Vitamin deficiency 5 Prolonged immobility
1, 3, 5
Which is a common symptom of hypokalemia? Select all that apply. One, some, or all responses may be correct. 1 Generalized weakness 2 Cool extremities 3 Dependent edema 4 Depressed reflexes 5 Irregular heart rate
1, 4, 5
Which is a symptom of left-sided heart failure? Select all that apply. One, some, or all responses may be correct. 1 Hacking cough 2 Dependent edema 3 Distended abdomen 4 Oliguria during the day 5 Frothy, pink-tinged sputum
1, 4, 5
A patient is receiving IV heparin therapy for a pulmonary embolism. Which antidote would the nurse confirm is available? 1 Vitamin K 2 Protamine sulfate 3 Aminocaproic acid 4 Antihemophilic factor
2
A patient with a tachydysrhythmia asks the nurse, "Why does my chest hurt?" Which information does the nurse use to base the explanation given to the patient? 1 A heart rate over 100 beats/min may cause palpitations. 2 The diastole is shortened, and coronary perfusion is decreased. 3 The aortic valve remains open, preventing coronary artery filling. 4 The conduction is delayed at the atrioventricular (AV) node, causing heart block.
2
The nurse is caring for a patient who is scheduled for a thrombectomy. Which information would the nurse provide to the patient? 1 "A stent will be implanted into the artery." 2 "The surgery is intended to remove the clot." 3 "The procedure will prevent future clot formation in the blood." 4 "The surgeon will inject a dye into the blood that dissolves the clot."
2
Which does the nurse consider at the start of captopril therapy that is prescribed to a patient with heart failure (HF)? 1 Liver function tests 2 The risk for hypotension 3 The potential for bradycardia 4 The risk for hypokalemia
2
Which drug would be administered to a patient after orthopedic surgery to prevent deep vein thrombosis? 1 Cilostazol 2 Enoxaparin 3 Pravastatin 4 Amlodipine
2
Which fact about unstable angina is correct? 1 It evolves over many hours. 2 It may occur at rest or with activity. 3 It lasts a few minutes and is relieved by rest. 4 It occurs in a pattern the patient typically recognizes.
2
The nurse identifies that which medication will be given to a patient who presents to the emergency department with chest pain, shortness of breath, diaphoresis, hypotension, and a heart rate of 56 beats/min? 1 Digoxin 2 Atropine 3 Verapamil 4 Propranolol
2 The administration of atropine along with IV fluids will increase intravascular volume and help to manage bradycardia.
Which is a common sign of right-sided heart failure? Select all that apply. One, some, or all responses may be correct. 1 A hacking cough 2 Dependent edema 3 Increase in weight 4 Nausea and anorexia 5 Oliguria during the day
2, 3, 4
Which factor increases the risk for secondary hypertension? Select all that apply. One, some, or all responses may be correct. 1 Smoking 2 Pregnancy 3 Kidney disease 4 Hyperlipidemia 5 Oral contraceptive use
2, 3, 5
A patient has developed a pulmonary embolism. Which laboratory test would the nurse anticipate being prescribed before beginning heparin therapy? 1 Kidney function tests 2 Arterial blood gases (ABGs) 3 Partial thromboplastin time (PTT) 4 International normalized ratio (INR)
3
Which cardiac rhythm typically deteriorates into ventricular fibrillation (VF)? 1 Atrial flutter 2 Atrial fibrillation 3 Ventricular tachycardia (VT) 4 Third-degree heart block
3
Which condition is a result of a hypereffective heart in a well-conditioned athlete? 1 Tachypnea 2 Dysrhythmia 3 Bradycardia 4 Cardiac arrest
3
Which description of arteriosclerosis is most accurate? Incorrect1 Cholesterol lining the arterial wall 2 Fat deposits along the arterial vessels 3 Thickening or hardening of the arterial wall 4 Enlargement of the diameter of blood vessels
3
Which drug poses a risk for the development of heart failure, especially in older adults? 1 Insulin 2 Digoxin 3 Ibuprofen 4 Potassium chloride
3
Which substance causes the collecting tubules in the kidneys to reabsorb sodium as part of a blood pressure (BP) control system? 1 Renin 2 Sodium 3 Aldosterone 4 Angiotensin-converting enzyme
3
Which action of ezetimibe prevents the risk for atherosclerosis? 1 By decreasing blood pressure 2 By decreasing cholesterol synthesis Correct3 By inhibiting cholesterol absorption 4 By inhibiting 3-hydroxy-3-methylglutaryl coenzyme A (HMG-CoA) reductase enzyme
3 Ezetimibe decreases the cholesterol level by inhibiting its absorption through the small intestine.
Which clinical manifestation prompts the nurse to suspect pulmonary edema in a patient with heart failure (HF)? Select all that apply. One, some, or all responses may be correct. 1 Increased urination 2 Bradycardia 3 Crackles 4 Dyspnea at rest 5 Disorientation regarding time and place
3, 4, 5
Which assessment finding is an indication of left-sided heart failure? 1 Nocturia 2 Peripheral edema 3 Swollen abdomen 4 Crackles in the lung fields
4
Which condition is believed to cause atherosclerosis? 1 Ischemia 2 Hypertension 3 Ruptured plaques 4 Blood vessel damage
4
Which drug prescribed to treat a patient's hypertension may exacerbate gout? 1 Torsemide 2 Furosemide 3 Triamterene 4 Hydrochlorothiazide
4
Which factor causes the greatest amount of complications for patients with atherosclerosis? 1 Hypertension 2 Inflammation 3 High-density lipoprotein (HDL) levels 4 Unstable plaque
4
Which factor is a direct cause of peripheral arterial disease (PAD)? 1 Diuretic use 2 Thromboembolism 3 Intermittent claudication 4 Systemic atherosclerosis
4
Which information regarding phosphodiesterase inhibitors and nitroglycerin administration is accurate? 1 Administered concomitantly for both to be effective 2 Administered within 24 hours of one another to be effective 3 May cause a pulmonary embolism if administered within 48 hours of one another 4 May cause significant hypotension if administered within 48 hours of one another
4
Which is considered "good" cholesterol? 1 Lipids 2 Triglycerides 3 Low-density lipoprotein cholesterol (LDL-C) 4 High-density lipoprotein cholesterol (HDL-C)
4
Which side effect is common in patients taking metoprolol? 1 Persistent cough 2 Diarrhea 3 Hypovolemia 4 Orthostatic hypotension
4
Which drug may interact with statins? 1 Niacin 2 Ezetimibe 3 Amlodipine 4 Cyclosporine
4 Taking these drugs together may significantly increase the statin blood level
Arteriosclerosis and Atherosclerosis
Arteriosclerosis -Thickening or hardening of arterial walls -Arteries become narrowed, blood flow decreased Atherosclerosis -Formation of plaque within arterial walls Interventions - Nutrition therapy - Physical activity - Drug therapy
Heart Failure
Causes . Left-sided -hypertension -coronary artery disease -valvular disease . Right-sided -left ventricular failure -right ventricular MI -pulmonary hypertension . High-output -septicemia -anemia hyperthyroidism Compensatory Mechanisms . When cardiac output is insufficient to meet body's demands, these mechanisms operate to increase . Cardiac output - Sympathetic nervous system stimulation - Renin-angiotensin system activation - Chemical responses (BNP) - Myocardial hypertrophy Signs/Symptoms . Left-Sided Heart Failure -weakness -fatigue -dizziness -acute confusion -pulmonary congestion -breathlessness -oliguria . Right-Sided Heart Failure -jugular vein distension -increased abdominal girth -dependent edema -hepatomeegaly -hepatojugular reflux -ascites -weight gain
Atrial fibrillation
Interventions - Correcting rhythm and controlling rate - Increase cardiac output - Prevention of thrombosis
Hypertension (HTN)
Mechanisms that influence blood pressure - Arterial baroreceptors - Regulation of body fluid - Renin-angiotensin-aldosterone system - Vascular autoregulation