NSG 6001 Midterm Exam Review with Answers (LATEST)

Maintenance of an Isometric ST-segment during exercise is the response of? A normal heart (Maintenance of an Isometric ST-segment during exercise is the response of a normal heart. ) The sensitivity of a routine ETT is effort dependent. What physiological changes occur during effort in the routine ETT? Increased coronary flow and increased systolic blood pressure (The physiological changes that occur during effort in the routine ETT are increased coronary flow and increased systolic blood pressure.) The diagnostic accuracy of stress testing is decreased among women compared to men for what reasons? Women usually have single vessel or non-obstructive disease (The diagnostic accuracy of stress testing is decreased among women compared to men because women usually have single vessel or non-obstructive disease.) What do you know regarding ischemia that is confined to only the posterior and or lateral segments of the left ventricle? m Difficult to detect by ETT (Ischemia that is confined to only the posterior and or lateral segments of the left ventricle is difficult to detect by ETT, but that does not mean that ETT cannot detect ischemia limited to these functional areas of the heart. ) n Your preceptor decides to add Doppler Flow studies to the echocardiogram exercise test for a patient with a recent history of a holistic murmur best auscultated at the left steral boarder. The patient has no history of cardiac surgeries. He asks you what might be the main advantages of adding Doppler Flow for this particular patient. You know from your readings that there are several reasons to add Doppler Flow and below are listed more than one correct reason. Your best response for this specific case, however, would be that Doppler Flow studies would be of what additive value during the echocardiogram study? Detect and evaluate blood shunting from a septal defect (Your best response for this specific case, however, would be that Doppler Flow studies would detect and evaluate blood shunting from a septal defect.) Your patient cannot sit on a bicycle and has difficulties walking a treadmill with limited capacity for exercising. Still, you know that the ETT is the preferred test for CAD. You consider adding a pharmacological agent to get to maximum heart rate. What agent would be the most commonly used agent to assist in an ETT? Dobutamine (The pharmacological agent most commonly used to assist in an ETT is dobutamine.) Medicare covers inpatient hospital services under which part of the Medicare insurance? Part A (Medicare covers inpatient hospital services under Part A. ) Medicare hospital insurance (Part A) is funded through what system? Federal payroll taxes (Medicare Part A is funded through federal payroll taxes. ) Your patient has a maximum age-predicted heart rate of 180. During the exercise he reaches a heart rate of 140 and then states he can no longer exercise. You see evidence of ischemic changes on the ECG. This would be predictive of what condition? Significant CAD (This scenario is predictive of significant CAD.) Your patient underwent an exercise stress test for CAD. There is significant elevation of the ST-segment. What do you need to know about these changes to manage your patient’s care? These changes have minimal predictive value for CAD (Significant elevation of the ST-segment has minimal predictive value for CAD. ) What purpose does the principle of fidelity serve in the provider/patient relationship? Ensures that providers honor their commitments to the patient (The principle of fidelity mandate assures that providers honor their commitments to the patient. ) After completion of the exercise stress test, you would measure the ST-segment depression after the J point of the QRS. The J point is located where in relation to the QRS? Term Junction between QRS and ST segment (The J point is located at the junction between QRS and ST-segment.) What ECG changes can reduce the specificity of the ETT? Paced rhythm and resting bundle branch block (The ECG changes that can reduce the specificity of the ETT are paced rhythm and resting bundle branch block. ) You are counseling a patient diagnosed with stress-induced ischemia. You base your discussion on your knowledge that stress-induced ischemia is thought to be caused by what phenomena? Endothelial dysfunction of the microvascular (You base your discussion on your knowledge that stress-induced ischemia is thought to be caused by endothelial dysfunction of the microvascular.) Medicaid is mandated to be provided by each state through federal codes. Each state must offer Medicaid exactly as the federal government prescribes. True or false? False (Medicaid is mandated to be provided by each state, however, Mediciad is not required to be delivered by any certain formula. Each state has autonomy to deliver Mediciad services under its own guidelines, provided that each state meets the federal guidelines for Medicaid coverage. ) You are considering adding an adjunctive form of testing to detect wall motion abnormalities during the ETT. You select Echocardiography as the added testing. You choose this test because you know that echocardiography does what when added to a standard ETT? You are considering adding an adjunctive form of testing to detect wall motion abnormalities during the ETT. You select Echocardiography as the added testing. You choose this test because you know that echocardiography does what when added to a standard ETT? The leads on the ECG showing ischemic changes during or immediately after an ETT can correlate roughly to the culprit artery or arteries with significant CAD. Is this true or false? True (This statement is true: the leads on the ECG showing ischemic changes during or immediately after an ETT can correlate roughly to the culprit artery or arteries with significant CAD. ) Of the answers below, which would be included in defining a positive Exercise Echocardiogram? Induced decrease in regional wall motion (Induced decrease in regional wall motion would be included in defining a positive exercise echocardiogram. Wall thickening would not traditionally occur in a positive test and hyperkinesis, not hypokinesis, generally occurs in a positive test.) Why would inability to exercise reduce the specificity of the routine ETT? Produces persistent ST-segmental changes and T-wave abnormalities (The inability to exercise reduces the specificity of the routine ETT because it produces persistent ST-segmental changes and T-wave abnormalities. ) In CAD, after both systolic and diastolic dysfunction have occurred, the typical pattern of chest pain and related EKG changes occur. During an EKG, you should expect to see ST-segment and T-wave changes that are central to demonstration of ischemia occurring relatively late in the ischemic cascade. Is this true or false? True (This is a true statement. During an EKG, you should expect to see ST-segment and T-wave changes that are central to demonstration of ischemia occurring relatively late in the ischemic cascade. ) What happens to coronary flow related to CAD? Hypo profusion of the myocardium (Because of the restrictive flow of blook through the coronary ateries, hypo profusion of the myocardium results from coronary flow related to CAD which causes the presenting symptoms. ) Chronic, non-communicable diseases account for disproportionate costs to the healthcare system. According to the World Health Organization, what percent of preventable deaths and disabilities occur in the Americas related to chronic non-communicable diseases? 60%-70% (According to the World Health Organization, 60%--7 0% of preventable deaths and disabilities occur in the Americas related to chronic non-communicable diseases. ) What is considered the first-line initial approach to test for CAD? Exercise Stress Test (Exercise stress test is considered the first-line initial approach to test for CAD. ) You are in the clinic with your mentor observing the Echocardiogram exercise test of a 45-year old male that has been experiencing slight chest pressure almost daily during exercise. While observing your patient, your mentor points out that the left ventricle wall is thinning and there is some hyperkinesias of the ventricular wall. From your time in the clinic, you know that this test will be considered to be what type of result? Positive (From your time in the clinic, you know because of wall thinning and hyperkinesis that this test will be considered to be positive.) What three conditions definitely alter the results of echocardiography in determining CAD? Obesity, rapid heart rate and lung disease (Obesity, rapid heart rate and lung disease definitely alter the results of echocardiography in determining CAD.) For women with known CAD and diabetes, which is most appropriate to assess CAD risk? ETT with imaging (ETT with imaging is most appropriate to assess CAD risk.) Ischemic changes on ECG during ETT is highly predictive of CAD. What is another important strong predictor of CAD that you might see during an ETT? Exercise-induced hypotension (Another important strong predictor of CAD that you might see during an ETT is exercise-induced hypotension. ) A 35 year old female arrives at your clinic. She has had diabetes and peripheral artery disease for the past 5 years. You decide to obtain an ETT. The insurance company argues that this is inappropriate. You justify the ETT because you are planning secondary strategies to prevent future heart disease. Where could one find the supporting data for these guidelines? Framingham risk score (These guidelines come from the Framingham risk score.) Your mentor says that you should be prepared to know how to determine the maximum heart rate for your patient during the ETT. How is the age-predicted maximum heart rate during an ETT determined? 220-age (The age-predicted maximum heart rate during an ETT determined by subtracting the patient’s age from 220 (220 – age). ) Population disease management is a term used to describe: High prevalence specific diseases (Population disease management is a term used to describe the high prevalence of specific diseases. )