fnp 2- Exam 2 -CARDIAC

What can a 69yo with heart failure and type 2 diabetes take for CAP? a. respiratory fluroquinolone b. amoxicillin with a beta-lactamase inhibitor c. cephalosporin d. a macrolide - Answer- a. respiratory fluroquinolone Levofloxacin (Levaquin) and moxifloxacin (Avelox) have excellent activity against strep pneumonia. Gaatiflozacin (Tequin) can also be given for CAP with comorbidity (incl. ETOH; CHF; chronic heart, lung, liver, or kidney disease; abx previous 3 months; DM; splenectomy/asplenia) You examine an 82yo woman who has a hx of HF. She is in the office b/c of increasing SOB. When auscultating her heart, you note tachycardia with a rate of 104bpm and an extra heart sound in early diastole. This sound most likely represents: a. summation gallop b. S3 c. opening snap d. S4 - Answer- b. S3 Marker of ventricular overload, systolic dysfunction, or both Heard in early diastole, can sound like it is "hooked on" to the back of the S2 Low pitch, best heard with bell, might miss with diaphragm Correlate with additional findings such as dyspnea, tachycardia, crackles You examine a 65yo man with dilated cardiomyopathy and HF. On exam, you exepect to find all of the following except: a. JVD b. tenderness on right upper abdominal quadrant palpation c. PMI at the 5th intercostal space, mid-clavicular line d. peripheral edema - Answer- c. PMI at the 5th intercostal space, mid-clavicular line Usually shifts laterally and perhaps over more than one ICS over in the presence of dilated cardiomyopathy and its resultant increase in cardiac size. One of the most underused classes of drugs in the treatment of HF is: a. beta blockers b. ACEIs c. calcium channel blockers d. loop diuretics - Answer- a. beta blockers Beta blockers have shown to improve cardiac function, to reduce myocardial ischemia, to decrease myocardial O2 consumption, and possibly reduce the incidence of sudden cardiac death. ACEIs and ARBs cause central and peripheral vasodilation, resulting in reduction of cardiac workload and improvement in cardiac output; they are the cornerstone of HF therapy. Diuretics assist with circulat