Nurs 620 Maryville Exam 2 Questions With Correct Answers 2024 (Verified)

Nurs 620 Maryville Exam 2 Questions With Correct Answers 2024 (Verified). Risk factors for hypertension correct answers 1. age & sex- women older than 55 & men older than 45 2.Obesity 3.Excessive dietary intake of salt ette smoking ic alcohol consumption 6.Family history of high blood pressure and/or cardiovascular disease 7.African American race 8.Stress 9.Sedentary lifestyle Blood pressure goals for JNC8 correct answers Healthy patients over 60 years of age is okay if it is below 150/90 Healthy patients less than 60 years of age the blood pressure is okay if less than 140/90 Patients with dx of DM or CKD regardless of age, goal BP is less than 140/90 lifestyle modifications for correct answers Weight reduction (BMI 18.5-24.9) DASH diet less than 2.4g a day of sodium Increase Pysical activity to 30min most days of the week Stop smoking Alcohol less than 2 drinks a day JNC8 preferred agents: correct answers -general population: thiazide CCB ACEI ARB -black: (without CKD) CCB or thiazide -DM: thiazide CCB ACEI ARB -CKD: ACE ARB Nurs 620 Maryville Exam 2 Questions With 100% Correct Answers 2023/2024 (Verified) Which medications for HTN should not be used together correct answers ACE and ARBS HTN therapy for patients over 75years old with impaired kidney function correct answers CCB Thiazides Classification of HTN per AHA correct answers Normal BP: less than 120 Systolic, diastolic less than 80 Elevated: 120-129 systolic, less than 80 diastolic Stage 1 HTN: 130-139/80-89 Stage 2 HTN: 140+/90+ Hypertensive crisis: 180+/120+ If goal not met for HTN in a month of treatment then what? correct answers Increase the intital dose of drug or add a second agent, if goal not achieved with 2 agents consider a 3rd agent. When HTN treatment is initiated or dose changed when should patient follow up correct answers 2-4 weeks, then once goal has achieved every 3-6 months. Diagnostic workup for HTN correct answers History- any symptoms? Physical examination What are their risk factors? - family history, smoking, drinking, sedentary lifestyle. Labs: BMP, CBC, UA, CMP, TSH, Lipid profile, ECG need to know kidney function, electrolytes, are they spilling protein in their urine. Work up for secondary causes of HTN correct answers Cushings- need a 24 hour urine Coarctation of the aorta- CXR Pheochromocytoma- 24 hour urine Primary hyperaldosteronism Renovascular hypertension- Renal arterogram, ultrasound of kidneys Resistant Hypertension correct answers failure to reach goal BP in patients who are taking full doses of an appropriate three-drug therapy regimen that includes a diuretic needs referral to cardiologist Causes of resistant HTN correct answers 1) Improper BP measurement 2) Excess Na+ intake 3) Inadequate diuretic Tx 4) Med issues such as inadequate doses, drug actions and interactions (e.g. NSAIDs, illicit drugs, sympathomimetics, OCPs), or OTC drugs and herbals 5) Excess EtOH intake 6) Underlying ID causes of HTN (2ndary) 7) White coat hypertension Complications of HTN correct answers Left ventricular hypertrophy Heart failure Ischemic Stroke Intracerebral hemmorage Ischemic heart disease CKD, ESRD Signs of target organ damage in Hypertension correct answers Headaches vision changes papillary edema change in mental status s/s heart failure hematuria, proteinuria, elevated creatinine Dyslipidemia--> Desirable/optimal serum lipid levels ****** correct answers Total cholesterol: less than 200mg/dl Triglycerides: less than 150mg/dl HDL: women greater than 45, men greater than 40, cardio protective is greater than 60 LDL: less than 100, DM 50-70 Screening for hyperlipidemia correct answers High Risk- • More than 1 risk factor - HTN, Smoking, Family hx • Single risk factor that is severe - i.e. siblings w/ CAD at a young age - Very heavy smoking history • Start screening at age 25 for men, age 35 for women • Repeat screening every 3 years Low Risk- • In the general population, guidelines indicate screening based on sex and age • Males - age 35 • Females - age 45 • Rescreening recommended every 5 years symptoms of hyperlipidemia correct answers A person with hyperlipidemia usually has no signs or symptoms. In familial, or inherited, hyperlipidemia, there may be yellowish fatty growths around the eyes or the joints. Hyperlipidemia is usually detected during a routine blood test, or following a cardiovascular event, such as a heart attack or stroke. How to manage hyperlipidemia correct answers • Therapy should be initiated when a patient's 10-year risk for a first atherosclerotic cardiovascular disease (ASCVD) event is 7.5% • This calculator can be found at - When would you initiate drug therapy for high cholesterol according to lab results? correct answers • Therapy should be initiated when a patient's 10-year risk for a first atherosclerotic cardiovascular disease (ASCVD) event is 7.5% Drug therapy for hyperlipidemia correct answers • HMG-CoA reductase inhibitors - STATINS • Non-statin therapy - no longer recommended - Bile acid sequestrates - Niacin - Gemfibrozil - trigs - Fenofibrate - trigs - Fish oils - trigs - Ezetimibe (Zetia) Statins- • Rovastatin - Crestor • Atorvastatin - Lipitor • Simvastatin - Zocor • Pravastatin - Pravachol • Lovastatin • Fluvastatin Rechecking labs for hyperlipidemia correct answers • LDL-C response at 6 weeks after initiating therapy • Every 6 to 12 months thereafter may be helpful in assessing medication adherence. • No need to monitor the LDL-C response to therapy other than to assess adherence, since we do not suggest intensifying the regimen for any particular level of LDL-C response Coranary Artery Disease (CAD) correct answers caused by plaque formation of cornary arteries, leads to restricted blood flow to the heart tissue. Angina vs MI correct answers Restricted blood flow to the heart that causes chest pain MI- obstruction within a coronary artery or arteries that blocks flow to the head resulting in inadequate blood supply to epicardium. Non-modifiable risk factors for CAD correct answers age (increased), gender (male), ethnicity (African american), family history, genetics Modifiable risk factors for CAD correct answers Smoking HTN DM obesity diet activity level hyperlipidemia Women: menopause w/o estrogen replacement or women on birth control. contributing factors for CAD correct answers Diabetes, obesity, sedentary lifestyle, stress Diagnostics for CAD correct answers ECG, exercise ECG (stress test), nuc scan( non exercise stress test), cardiac cath, intravascular ultrasonogrophy. CRP Management of CAD correct answers Start with Risk factor modification Control the symptoms (Nitro sublingual) preventing disease progression fibrolytic agents PCI CABG Medications for CAD correct answers beta blockers, aspirin, statins, nytrates acute coronary syndrome (ACS) Stages correct answers Stable angina- pain with exertion, resolves with rest Unstable angina- pain at rest variant angina - varies Myocardial infarction Non MI causes of chest pain correct answers PE- ask about hx of DVT's, extended traveling Aortic dissextion Tension pnumo cardiac temponade esophogeal rupture panic attacks HPI of chest pain correct answers Onset (abrupt or gradual) Size of pain (substernal, chest wall, localized) Provocation/palliation(which activies make it better or worse) Quality of pain (sharp, dull, pleuritic, squeezing) Radiation Timing (constant or episodic, duration of episodes, when it began) Associated symptoms (syncope, dyspnea) Typical chest pain of Acute Mi correct answers Substernal compression or crush pressure tightness, heaviness, cramping, aching Unexplained indigestion, belching, epigastric pain radiating pain to neck, jaw, shoulders, back or both arms dyspnea, N/V, diaphoresis Other important MI questions correct answers •Prior or recent cardiac testing? •Change in activity tolerance? •Symptoms w/ a prior MI (if applicable) •Comorbities: HTN, DM, HLD, family hx PVD, malignancy •Recent trauma, procedures or travel? •Substance abuse? •Medication use? •Smoker? ACS/MI Diagnostics correct answers •ECG- send to ED even if normal and patient looks awful. In ED: •Cardiac-specific troponin I and T (cTnI and cTnT) •Serum cardiac enzymes, which include the specific MB isoenzyme of CPK (CPKmb) •Myoglobin •Complete blood count (CBC), erythrocyte sedimentation rate (ESR), serum electrolytes, blood urea nitrogen (BUN), and serum creatinine Murmurs history correct answers Dizziness? palipations? hx of being told they have murmur? Murmurs Physical exam correct answers -Timing (is it every beat, every 5 beats?) -Quality (is it sharp and crisp, subtle wooshing) -Intensity( scale of 1-6, 1 is quiet and 6 is very loud) -Location (mid sternal border, where is it the loudest?) Diagnostic workup for murmurs correct answers -ECG (also think about halter monitor) -Chest radiograph -Cardiac ultrasound -Echo -Stress test Cardiology referral Asymptomatic systolic murmur correct answers Ejection murmur- usually high pitched, heard best at MSB Reguritation murmurs correct answers mitral valve incompetence •Causes -Rheumatic mitral valve disease -Bacterial endocarditis -Dilated cardiomyopathy -Papillary muscle rupture -Endocardial fibrosis •Fen-fen Ejection Murmurs correct answers •Early aortic and pulmonic valve disease •Calcific aortic stenosis •Aortic sclerosis •IHSS-Idiopathic hypertrophic subaortic stenosis •Atrial septal defects Causes of ejection murmurs correct answers •Causes -Fever -Anemia -Pregnancy -Hyperthyroidism -Exercise -Aortic regurgitation -Bradycardia -ASD-arterial septal defect -HTN -aging Atrial Fibrillation correct answers -Irregularly irregular rhythm • •Presentation -Rapid HR -Dizziness -SOB -Lightheadedness -Hypotension Dignostic work up for afib correct answers •ECG •TSH •BMP •Chest pain •JVD •Crackles •S3 Treatment for afib correct answers •Establish rate control -Hemodynamically unstable->ED •Beta-blockers •Calcium-channel blockers