N406 EXAM 2 UPDATED ACTUAL QUESTIONS AND
CORRECT ANSWERS
Question:
1. blood pressure
Answer:
- correct arm cuff size
- sit quietly w arm at heart lvl
- confirmation of dx by avg of 2 BP readings
NORMAL
- systolic < 120, diastolic < 80
ELEVATED
- systolic = 120-129, diastolic < 80
STAGE 1 HTN
- systolic = 130-139, diastolic = 80-89
STAGE 2 HTN
- systolic > 140, diastolic > 90
HYPERTENSIVE URGENCY
- BP > 180/120 but no evidence of organ damage
--> goal: dec BP gradually over 24-48 hrs
- PO drugs: catopril, clonidine, labetalol
- monitor BP q5-15 min during titration to avoid hypotension
HYPERTENSIVE EMERGENCY
- BP > 180/120 with evidence of organ damage
--> goal: gradually dec BP by 10-20% in 1st hr --> then to <160/100 over hrs
- IV drugs: nitroglycerin (chest pain), labetalol, nicardipine, sodium nitropusside
- position pt in semi fowlers
Question:
2. S/S of HTN
Answer:
- headaches
- dizziness/ lightheadedness
- nosebleeds
- blurred/double vision
- SOB
- chest pain/ tightness
- fatigue
- confusion
Question:
3. Complications of HTN
,Answer:
HEART:
- MI
- HF
- aneurysm
BRAIN:
- stroke
- cog decline
- transient ischemic attack
KIDNEYS
- narrowed kidney arteries
- kidney scarring (glomerulosclerosis)
EYES
- reduced blood flow to optic nerve
Question:
4. frothy sputum
Answer:
pulmonary edema or pulmonary embolism
Question:
5. ADVERSE EFFECTS OF ANTIHYPERTENSIVES
Answer:
beta blockers also mask hypoglycemia
Question:
6. for pts w uncomplicated HTN & no specific indications for another med, what is the recommended
initial medication?
a. thiazide diuretic
b. CCBs
c. vasodilators
d. ACE inhibitors
Answer:
a. thiazide diuretics
Question:
7. ischemia vs infarction
,Answer:
ISCHEMIA
- blood flow decd
--> hypoxia - insufficient o2
INFARCTION
- blood flow cut off due to prolonged ischemia
--> necrosis - cellular death
- cell death measured by troponin
Question:
8. ISCHEMIA
Answer:
S/S:
- chest pain/ discomfort (angina) usu left side
- SOB, fatigue, nausea, sweating
- mild, transient, shorter, reversible, relieved by rest or nitro
- mild tachycardia or HTN
- no sig changes in RR
- episodic, predictable
- atypical signs in older adults, women, diabetics --> indigestion, nausea
DX:
- ST-segment depression, T-wave inversion, new Q-waves
- no sig ST elevation unless progressing to infarction
- troponin I/T may remain normal or show minimal elevation
- WBC
- C reactive
Question:
9. INFARCTION
Answer:
S/S
- chest pain, SOB, N/V, sweating, syncope
- tachycardia, HT, irreg rhythms, resp distress, crackles, pale cool clammy skin due to poor perfusion or
shock
- acute, persistent, worsen over time
- unrelieved by nitro
- atypical = epigastric pain, HT, tachycardia
DX:
- EKG --> ST-segment elevation (STEMI), or ST-seg depression (Non-STEMI), T-wave inversion
CARDIAC BIOMARKERS
- myoglobin --> rises earliest at 1-4 hrs post MI, non specific bc found in skeletal muscle
- Troponin I/T --> rises 3-12 hrs post MI, highly specific bc it is found almost exclusively in myocardial
cells/heart muscle
- CK-MB --> rises 4-12 hrs, less specific
- total CK --> rises later, non-specific
, Question:
10. WHY DOES MYOGLOBIN RISE EARLIEST IN MI? WHY IS IT LESS SPECIFIC THAN
TROPONIN?
Answer:
- small size: rises earliest bc it's small allowing it to pass quickly from damaged muscle into bloodstream
& thru filtration
- location: free in cytoplasm instead of bound; also found in skeletal muscle so may become elevated due
to trauma or strenuous activity
Question:
11. importance of elevated troponin I in unstable angina **
Answer:
- accurate indicator of myocardial injury
- specific to cardiac muscle, unlike myoglobulin
--> monitor for chest pain, ECG changes, prep for cardiac interventions, edu on myocardial injury
Question:
12. TYPES OF STROKE
Answer:
ISCHEMIC
- caused by clot blocking cerebral artery
HEMORRHAGIC
- caused by ruptured blood vessel
TRANSIENT ISCHEMIC ATTACK (TIA)
- "mini stroke" w temp symptoms caused by brief blockage
- lasts <1 hr, no permanent damage
Question:
13. STROKE ASSESSMENT
Answer:
F - Facial drooping A - Arm weakness S - Speech difficulty T - Time to call for help if any of these signs
are present
- requires IMMEDIATE ACTION as thrombolytics must be admin w/in
4.5 hrs
- sudden severe headache (hemorrhagic stroke), confusion, vision loss, dizziness, loss of
balance/coordination
- assess ABC, LOC, vitals, glucose, electrolytes, renal function, coagulation studies
- perform neuro exam
IMAGING
- CT or MRI to differentiate ischemic vs hemorrhagic stroke
Question:
14. HF
CORRECT ANSWERS
Question:
1. blood pressure
Answer:
- correct arm cuff size
- sit quietly w arm at heart lvl
- confirmation of dx by avg of 2 BP readings
NORMAL
- systolic < 120, diastolic < 80
ELEVATED
- systolic = 120-129, diastolic < 80
STAGE 1 HTN
- systolic = 130-139, diastolic = 80-89
STAGE 2 HTN
- systolic > 140, diastolic > 90
HYPERTENSIVE URGENCY
- BP > 180/120 but no evidence of organ damage
--> goal: dec BP gradually over 24-48 hrs
- PO drugs: catopril, clonidine, labetalol
- monitor BP q5-15 min during titration to avoid hypotension
HYPERTENSIVE EMERGENCY
- BP > 180/120 with evidence of organ damage
--> goal: gradually dec BP by 10-20% in 1st hr --> then to <160/100 over hrs
- IV drugs: nitroglycerin (chest pain), labetalol, nicardipine, sodium nitropusside
- position pt in semi fowlers
Question:
2. S/S of HTN
Answer:
- headaches
- dizziness/ lightheadedness
- nosebleeds
- blurred/double vision
- SOB
- chest pain/ tightness
- fatigue
- confusion
Question:
3. Complications of HTN
,Answer:
HEART:
- MI
- HF
- aneurysm
BRAIN:
- stroke
- cog decline
- transient ischemic attack
KIDNEYS
- narrowed kidney arteries
- kidney scarring (glomerulosclerosis)
EYES
- reduced blood flow to optic nerve
Question:
4. frothy sputum
Answer:
pulmonary edema or pulmonary embolism
Question:
5. ADVERSE EFFECTS OF ANTIHYPERTENSIVES
Answer:
beta blockers also mask hypoglycemia
Question:
6. for pts w uncomplicated HTN & no specific indications for another med, what is the recommended
initial medication?
a. thiazide diuretic
b. CCBs
c. vasodilators
d. ACE inhibitors
Answer:
a. thiazide diuretics
Question:
7. ischemia vs infarction
,Answer:
ISCHEMIA
- blood flow decd
--> hypoxia - insufficient o2
INFARCTION
- blood flow cut off due to prolonged ischemia
--> necrosis - cellular death
- cell death measured by troponin
Question:
8. ISCHEMIA
Answer:
S/S:
- chest pain/ discomfort (angina) usu left side
- SOB, fatigue, nausea, sweating
- mild, transient, shorter, reversible, relieved by rest or nitro
- mild tachycardia or HTN
- no sig changes in RR
- episodic, predictable
- atypical signs in older adults, women, diabetics --> indigestion, nausea
DX:
- ST-segment depression, T-wave inversion, new Q-waves
- no sig ST elevation unless progressing to infarction
- troponin I/T may remain normal or show minimal elevation
- WBC
- C reactive
Question:
9. INFARCTION
Answer:
S/S
- chest pain, SOB, N/V, sweating, syncope
- tachycardia, HT, irreg rhythms, resp distress, crackles, pale cool clammy skin due to poor perfusion or
shock
- acute, persistent, worsen over time
- unrelieved by nitro
- atypical = epigastric pain, HT, tachycardia
DX:
- EKG --> ST-segment elevation (STEMI), or ST-seg depression (Non-STEMI), T-wave inversion
CARDIAC BIOMARKERS
- myoglobin --> rises earliest at 1-4 hrs post MI, non specific bc found in skeletal muscle
- Troponin I/T --> rises 3-12 hrs post MI, highly specific bc it is found almost exclusively in myocardial
cells/heart muscle
- CK-MB --> rises 4-12 hrs, less specific
- total CK --> rises later, non-specific
, Question:
10. WHY DOES MYOGLOBIN RISE EARLIEST IN MI? WHY IS IT LESS SPECIFIC THAN
TROPONIN?
Answer:
- small size: rises earliest bc it's small allowing it to pass quickly from damaged muscle into bloodstream
& thru filtration
- location: free in cytoplasm instead of bound; also found in skeletal muscle so may become elevated due
to trauma or strenuous activity
Question:
11. importance of elevated troponin I in unstable angina **
Answer:
- accurate indicator of myocardial injury
- specific to cardiac muscle, unlike myoglobulin
--> monitor for chest pain, ECG changes, prep for cardiac interventions, edu on myocardial injury
Question:
12. TYPES OF STROKE
Answer:
ISCHEMIC
- caused by clot blocking cerebral artery
HEMORRHAGIC
- caused by ruptured blood vessel
TRANSIENT ISCHEMIC ATTACK (TIA)
- "mini stroke" w temp symptoms caused by brief blockage
- lasts <1 hr, no permanent damage
Question:
13. STROKE ASSESSMENT
Answer:
F - Facial drooping A - Arm weakness S - Speech difficulty T - Time to call for help if any of these signs
are present
- requires IMMEDIATE ACTION as thrombolytics must be admin w/in
4.5 hrs
- sudden severe headache (hemorrhagic stroke), confusion, vision loss, dizziness, loss of
balance/coordination
- assess ABC, LOC, vitals, glucose, electrolytes, renal function, coagulation studies
- perform neuro exam
IMAGING
- CT or MRI to differentiate ischemic vs hemorrhagic stroke
Question:
14. HF
