NR 545 EXAM REVIEW QUESTIONS AND
ANSWERS
Atherosclerosis Pharm - Answer-Pharm: Antiplatelets (Aspirin)
Statins- reduce inflammation.
ACE Inhibitor- relax blood pressure and reduce work and pressure on heart.
Can be treated with lifestyle management.
Heart Failure - Answer-complex clinical syndrome that results from structural or
functional impairment of ventricular or ejection of blood, which in turn leads to the
cardinal clinical symptoms of dyspnea and fatigue, edema, and rales.
Heart Failure PA - Answer-Pre-existing conditions such as diabetes, liver failure, renal
disease, anemia.
Dyspnea on exertion, orthopnea, paroxysmal nocturnal dyspnea (PND), nocturnal
angina, Cheyne-Stokes respirations (ask families or caretaker)
Fatigue, lethargy, decreased functional capacity Patient takes medications as directed,
observing, and adhering to dietary requirements.
Alcohol or tobacco use
History of rheumatic heart disease or Chaga's disease
Discomfort when laying down.
Hypertension
Tachycardia
HF Dx - Answer-CBC, electrolytes, BUN, serum creatinine, hepatic enzymes, and a
urinalysis to screen for diabetes mellitus
Fasting lipid panel and TSH
B-type natriuretic peptide (BNP) and N-Terminal pro-BNP (NT-proBNP) are released
from a failing heart and a sensitive marker for the presence of HF
Newer markers, soluble ST-2, and galectin-3 are used to determine the prognosis of HF
patients
Chest Xray to show the size and shape of the heart, as well as pulmonary vasculature
Electrocardiogram 12-lead; assess for cardiac rhythm, and if LV hypertrophy is present,
prior MI, QRS width. A normal ECG can exclude any LV systolic dysfunction.
Echocardiogram two-dimensional (2-D) assessment of LV size and function, as well as
valvular function or dysfunction and wall motion abnormalities (indicative of prior MI
damage). With Doppler can also assess RV size and pulmonary pressures for
evaluation and management of cor-pulmonale.
MRI is the gold standard for assessing LV mass and volume
HF Pharm - Answer-Pharm: First line pharmacological management of heart failure is
as follows:
Asymptomatic Treatment:
, Ace Inhibitor - Venous/Arterial vasodilation
- Drug/Dosing: Enalapril 2.5mg three times a day
Angiotensin II Receptor Blocker - Venous/Arterial vasodilation
- Drug/Dosing: Losartan 25-40mg per day
Symptomatic Treatment:
Beta Blockers - Blocks receptors of adrenergic nervous system
- Drug/Dosing: Coreg 6.25-25mg twice a day
HCN Channel Blockers - Blocks
Hyperpolarization-Activated Cyclic Nucleotide-Gated Channel (HCN) in SA node to
decrease heart rate
- Drug/Dosing: Corlanor 5mg twice a day for two weeks, then 5mg per day
Diuretics - Inhibits sodium chloride reabsorption
- Drug/Dosing: HCTZ 12.5-50mg per day
- Drug/Dosing: Lasix 20-80mg per day
Antiarrhythmics - Inhibits sodium-potassium ATPase
- Drug/Dosing: Digitalis 3.4-5.1mcg/kg per day
Nonpharm: Salt restriction to 2gm/day
Considerations: Avoid NSAIDs, antiarrhythmic drugs, calcium channel blockers
Restrict fluid to 2L/day
Hypertension - Answer-elevated blood pressure is a result of increased resistance to
arterial blood flow
HTN PA - Answer-Physical Assessment: headaches
Dizziness
Blurred vision
Fatigue
HTN Dx - Answer-Dx: after two consecutive clinic visits with BP readings above 130/80
potassium- Low potassium can increase BP
Sodium- high sodium levels can elevate BP
Blood glucose and HgA1C to assess for hyperglycemia and diabetes.
Lipid panel to assess for hyperlipidemia or metabolic syndrome.
Creatinine and blood urea nitrogen and ultrasound of kidneys to assess for secondary
hypertension.
TSH and T4 to assess for secondary hypertension due to abnormal thyroid function.
HTN Tx - Answer-Pharm: Modifiable lifestyle changes
Low sodium diet
ANSWERS
Atherosclerosis Pharm - Answer-Pharm: Antiplatelets (Aspirin)
Statins- reduce inflammation.
ACE Inhibitor- relax blood pressure and reduce work and pressure on heart.
Can be treated with lifestyle management.
Heart Failure - Answer-complex clinical syndrome that results from structural or
functional impairment of ventricular or ejection of blood, which in turn leads to the
cardinal clinical symptoms of dyspnea and fatigue, edema, and rales.
Heart Failure PA - Answer-Pre-existing conditions such as diabetes, liver failure, renal
disease, anemia.
Dyspnea on exertion, orthopnea, paroxysmal nocturnal dyspnea (PND), nocturnal
angina, Cheyne-Stokes respirations (ask families or caretaker)
Fatigue, lethargy, decreased functional capacity Patient takes medications as directed,
observing, and adhering to dietary requirements.
Alcohol or tobacco use
History of rheumatic heart disease or Chaga's disease
Discomfort when laying down.
Hypertension
Tachycardia
HF Dx - Answer-CBC, electrolytes, BUN, serum creatinine, hepatic enzymes, and a
urinalysis to screen for diabetes mellitus
Fasting lipid panel and TSH
B-type natriuretic peptide (BNP) and N-Terminal pro-BNP (NT-proBNP) are released
from a failing heart and a sensitive marker for the presence of HF
Newer markers, soluble ST-2, and galectin-3 are used to determine the prognosis of HF
patients
Chest Xray to show the size and shape of the heart, as well as pulmonary vasculature
Electrocardiogram 12-lead; assess for cardiac rhythm, and if LV hypertrophy is present,
prior MI, QRS width. A normal ECG can exclude any LV systolic dysfunction.
Echocardiogram two-dimensional (2-D) assessment of LV size and function, as well as
valvular function or dysfunction and wall motion abnormalities (indicative of prior MI
damage). With Doppler can also assess RV size and pulmonary pressures for
evaluation and management of cor-pulmonale.
MRI is the gold standard for assessing LV mass and volume
HF Pharm - Answer-Pharm: First line pharmacological management of heart failure is
as follows:
Asymptomatic Treatment:
, Ace Inhibitor - Venous/Arterial vasodilation
- Drug/Dosing: Enalapril 2.5mg three times a day
Angiotensin II Receptor Blocker - Venous/Arterial vasodilation
- Drug/Dosing: Losartan 25-40mg per day
Symptomatic Treatment:
Beta Blockers - Blocks receptors of adrenergic nervous system
- Drug/Dosing: Coreg 6.25-25mg twice a day
HCN Channel Blockers - Blocks
Hyperpolarization-Activated Cyclic Nucleotide-Gated Channel (HCN) in SA node to
decrease heart rate
- Drug/Dosing: Corlanor 5mg twice a day for two weeks, then 5mg per day
Diuretics - Inhibits sodium chloride reabsorption
- Drug/Dosing: HCTZ 12.5-50mg per day
- Drug/Dosing: Lasix 20-80mg per day
Antiarrhythmics - Inhibits sodium-potassium ATPase
- Drug/Dosing: Digitalis 3.4-5.1mcg/kg per day
Nonpharm: Salt restriction to 2gm/day
Considerations: Avoid NSAIDs, antiarrhythmic drugs, calcium channel blockers
Restrict fluid to 2L/day
Hypertension - Answer-elevated blood pressure is a result of increased resistance to
arterial blood flow
HTN PA - Answer-Physical Assessment: headaches
Dizziness
Blurred vision
Fatigue
HTN Dx - Answer-Dx: after two consecutive clinic visits with BP readings above 130/80
potassium- Low potassium can increase BP
Sodium- high sodium levels can elevate BP
Blood glucose and HgA1C to assess for hyperglycemia and diabetes.
Lipid panel to assess for hyperlipidemia or metabolic syndrome.
Creatinine and blood urea nitrogen and ultrasound of kidneys to assess for secondary
hypertension.
TSH and T4 to assess for secondary hypertension due to abnormal thyroid function.
HTN Tx - Answer-Pharm: Modifiable lifestyle changes
Low sodium diet
