NUR MISC Week 4 – Chronic Cardiovascular Conditions (SOLVED) Questions/Answers

NUR MISC Week 4 – Chronic Cardiovascular Conditions Being on a blood thinner means the blood is more watery. FALSE An elderly female without prior history of cardiovascular disease reports lower leg soreness and fatigue when shopping or walking in the neighborhood. The primary care provider notes decreased pedal pulses bilaterally. Which test will the provider order initially to evaluate for peripheral arterial disease based on these symptoms? Your patient, an asymptomatic 80-year-old receiving treatment for HTN (and reporting no adverse effects) consistently presents with BPs > 140/80 but less than 150/90. According to the Joint National Committee (JNC) 8 recommendations, what approach to her HTN management would you have (in addition to reviewing compliance and diet)? Abruptly discontinuing an alpha2 agonist such as clonidine can cause rebound hypotension. TRUE The foods that are richest in Vitamin K are: The reversal agent for the target-specific oral anticoagulants (TSOACs) is Warfarin Heparin Vitamin K Fresh frozen plasma (FFP) None of the above; there is no FDA-approved reversal agent A 56-year-old male presents to the emergency department with dyspnea, fatigue, and poor exercise tolerance that has increased over the past month. He reports that he has been on a diet but has gained 20 pounds over the last month. An echocardiogram is ordered and shows an ejection fraction of 35%. Which laboratory tests do you want to order? (Choose all that apply.) B-type natriuretic peptide Thyroid-stimulating hormone Complete metabolic panel Urinalysis A patient reports sustained, irregular heart palpitations. What is the most likely cause of these symptoms? Anemia Atrial Fibrillation Extrasystole Paroxysmal attacks A 65-year-old woman presents to you for her first visit because she needs dental work and was found to have elevated BP when she saw the dentist. She tells you that she has never been to a doctor in her life, except when she had her two children over 40 years ago. Possible physical findings related to long-standing untreated HTN in this patient might include which of these findings? Cardiac exam: S4 Fundoscopic exam: Arteriolar nicking Abdominal exam: umbilical hernia Extremity exam: Varicose veins A and B A, c, and d All of the above A 56-year-old male presents to the emergency department with dyspnea, fatigue, and poor exercise tolerance that has increased over the past month. He reports that he has been on a diet but has gained 20 pounds over the last month. An echocardiogram is ordered and shows an ejection fraction of 35%. You would describe and classify his type of heart failure as: HFrEF HFpEF Left ventricular failure Right ventricular failure Which of the following medications are used to improve perfusion in patients with HFrEF? (choose all that apply) Correct! Enalapril Torsemide Diltiazem Carvedilol A 55-year-old patient has a blood pressure of 138/85 on three occasions. The patient denies headaches, palpitations, snoring, muscle weakness, and nocturia and does not take any medications. What will the provider do next to evaluate this patient? Continue to monitor blood pressure at each health maintenance visit Assess serum cortisol levels Refer to a specialist for a sleep study Order urinalysis, CBC, BUN, and creatinine All the following are true about TSOACs except: Correct Answer They can be safely used in patient with renal failure They do not have a monitoring test They have a very short half-life They can interact with other medications They are not affected by foods or supplements Which of the following symptoms are most commonly associated with heart failure? Chest pain, nausea, edema, coughing Fatigue, dyspnea, fluid retention, exercise intolerance Weakness, fatigue, euvolemia, leg pain Palpitations, shortness of breath on exertion, weakness, heat intolerance Caution should be used when starting which of the following medications in a patient with heart failure with elevated filling pressures? Amiloride Losartan Metoprolol Furosemide Factors to consider in prescribing warfarin to an elderly patient include all of the following except: Cognitive impairment Dependency on others for warfarin administration Fall risk Financial status Which of the following medications are used to improve perfusion in patients with HFrEF? (choose all that apply) Torsemide Carvedilol Enalapril Diltiazem You are considering initiating warfarin for a 76-year-old male with newly diagnosed atrial fibrillation. He carries the diagnoses of hypertension and diabetes. What is his CHADS2 score? 3 4 1 2 A 45-year-old otherwise healthy Latina woman patient has had four BP readings in the past 6 months ranging from 145–155/79–82. What treatment do you recommend at this time? Screen for white coat hypertension. Advise on lifestyle modifications and start a low dose of an antihypertensive such as an ACEI or diuretic. Ask her to check BPs at home for 6 months and return to clinic with these values. Advise to try lifestyle modifications for 6 months and then reassess. You are seeing a 45-year-old female with new onset of atrial fibrillation (AF). Evaluation shows no underlying cause of her AF. She has no other significant health problems. The recommended anticoagulation treatment for this patient is: Begin warfarin immediately Consider warfarin if her ventricular rate goes above 100 Recommend aspirin 325 mg/d No treatment indicated Which of the following disease processes may contribute to the worsening of HFpEF? (choose all that apply) CCC Obstructive sleep apnea Diabetes mellitus Atrial fibrillation Angina Many medications interact with warfarin. The following medications can cause significant alteration of the INR: Amiodarone Sulfamethazole/trimethoprim Erythromycins All the above Being on a blood thinner means the blood is more watery. True False A patient who has Class II heart failure is taking an ACE inhibitor and reports a recurrent cough that does not interfere with sleep or activity. What will the provider do initially to manage this patient? Assess serum potassium and sodium immediately Discontinue the ACE inhibitor and prescribe an ARB Provide reassurance that this is a benign side effect Withhold the drug and evaluate renal and pulmonary function A child with a history of asthma is brought to the clinic with a rapid heart rate. A cardiac monitor shows a heart rate of 225 beats per minute. The provider notifies transport to take the child to the emergency department. What initial intervention may be attempted in the clinic? Administration of intravenous adenosine Giving a beta blocker Providing a loading dose of digoxin Using a vagal maneuver or carotid massage Which are causes of secondary hypertension? (Select all that apply.) Increased salt intake Isometric exercises Nonsteroidal anti-inflammatory drugs Oral contraceptives Sleep apnea A young female patient has known mitral valve prolapse. During a routine health maintenance exam, the provider notes an apical systolic murmur and a midsystolic click on auscultation. The patient denies chest pain, syncope, or palpitations. What will the provider do? Admit the patient to the hospital for evaluation and treatment Consult with the cardiologist to determine appropriate diagnostic tests Continue to monitor the patient every 3 years Reassure the patient that these findings are expected An adult patient reports frequent episodes of syncope and lightheadedness. The provider notes a heart rate of 70 beats per minutes. What will the provider do next? Evaluate the patient’s orthostatic vital signs Monitor the patient’s heart rate while the patient is bearing down Order an electrocardiogram and exercise stress test Reassure the patient that the symptoms are non-cardiac in origin If a dose of warfarin is missed, the patient should take a double dose the next day. True False An African-American patient who is being treated with a thiazide diuretic for chronic hypertension reports blurred vision and shortness of breath. The provider notes a blood pressure of 185/115. What is the recommended action for this patient? Add a beta blocker to the patient’s regimen Admit to the hospital for evaluation and treatment Increase the dose of the thiazide medication Prescribe a calcium channel blocker Right heart failure symptoms predominantly consist of dyspnea. True False Hypertension is a risk factor that can lead to heart failure. True False Cough, orthopnea, dyspnea on exertion, and confusion are signs of right ventricular failure. True False A patient has a cardiac murmur with a mid-systolic click and is best heard along the left sternal border. The provider determines that the murmur decreases in intensity when the patient changes from standing to squatting and increases in intensity with the Valsalva maneuver. Which cause will the provider suspect for this murmur? Aortic stenosis Hypertrophic cardiomyopathy Mitral valve prolapse Tricuspid regurgitation According to JNC 8 recommendations, at which BP level do you initiate pharmacologic treatment for HTN in a 19-year-old diabetic male? Greater than or equal to 125/80 Greater than or equal to 140/90 Greater than or equal to 130/90 Greater than 135/85 The mainstay of treatment of heart failure with preserved ejection fraction (HFrEF) includes which of the following? Beta blocker Angiotensin-converting enzyme inhibitor (ACEI) Diuretic All of the above Heart failure is a clinical diagnosis. True False Your patient, Mr. Smith, is a 56-year-old moderately overweight African American hospital administrator with HTN. He has a FHx of DM but has had consistently negative screening labs for DM. He has been exercising regularly, is a nonsmoker, and has lost 10 lb over the past 6 months. Until recently, he has maintained a BP < 140/90 on HCTZ 25 mg daily. The past 3 months his BP has been creeping upward and at his current visit is 160/94. In addition to checking labs and discussing his diet and stress, you decide to alter his medication regimen by: Adding an angiotensin converting enzyme inhibitor Increasing the HCTZ to 50 mg daily Adding a calcium channel blocker None of the above; advise on lifestyle only till next visit The normal International Normalized Ratio (INR) range for a patient without liver disease is: 1.0–2.0 0.8–1.2 2.0–3.0 3.0–4.0 A patient who has been diagnosed with heart failure for over a year reports being comfortable while at rest and experiences palpitations and dyspnea when walking to the bathroom. Using the Canadian Cardiovascular Society Classification system, which classification of heart failure is appropriate based on these symptoms? A patient is diagnosed with PAD and elects not to have angioplasty after an angiogram reveals partial obstruction in lower extremity arteries. What will the provider recommend to help with relief of symptoms in this patient? Which of the following over-the-counter products (taken regularly) should be considered as a possible factor in elevating BP? Mrs. Taylor is a 79-year-old widowed white woman who lives alone and whom you have been treating for HTN, knee degenerative joint disease, and depression for 5 years. She is taking a diuretic, an ACEI, and a low dose of a beta blocker, all started by her former primary care physician before she transferred care to you. At this visit her BP has risen to 170/80, checked twice by you during the visit. Which of the following is not necessary to include in the history portion of the exam today? Explore her compliance with taking her prescribed medications. Discuss her diet. Inquire about social support and spirituality. Ask about her knee pain and how she is managing it. At her first visit with you, Ms. Ryan, a 55-year-old school teacher, is checked in by the medical assistant with a blood pressure of 155/92. Ms. Ryan reports no history of HTN or CVD disease and is asymptomatic. Repeat BP performed by you gives a reading of 148/85. In addition to ordering lab work and an ECG, you: Suggest lifestyle modifications such as weight loss, stress reduction, and a DASH diet, and start Ms. Ryan on hydrochlorothiazide (HCTZ) 12.5 mg daily Suggest lifestyle modifications (as above), refer Ms. Ryan for an exercise stress test, and start a beta blocker daily Suggest lifestyle modifications and start an ACEI Discuss lifestyle modifications and schedule Ms. Ryan back for repeat BP readings in 2–4 weeks Pump failure from left ventricular systolic dysfunctional A 68-year-old male with a history of HFpEF for 5 years has developed atrial fibrillation. You have initiated amiodarone. What do you need to monitor after initiation of this medication? (Choose all that apply.) Liver function panel Pulmonary fibrosis Renal function Thyroid-stimulating hormone Which are factors can cause a heart murmur? (Select all that apply.) Backward flow through a septal defect Backward flow into a normal vessel Forward flow into a dilated vessel High rates of flow through a normal valve Low rates of flow into a cardiac chamber A patient who has heart failure with reduced ejection fraction will have which symptoms? In a patient older than age 50, an elevated diastolic BP is a stronger risk factor for cardiovascular disease than elevated systolic BP The reversal agent for warfarin is: When starting warfarin as an outpatient, the blood should be checked within: A 75-year-old patient reports pain and a feeling of tiredness in both legs that only relieves after sitting for 30 minutes or more. What does the provider suspect as the cause for these symptoms? Buerger’s disease Peripheral arterial disease Diabetic neuropathy