NU372 Final Exam complete study set
Questions with simplified correct
Answers
Angina - correct answer--chest pain brought about by *myocardial ischemia*
*Manifestations:*
-*Chest Pain*: substernal, precordial, may *radiate to neck/arms/shoulders or jaw*
-Usually lasts *2-5 minutes*
-Quality: tight, squeezing, constricting, heavy sensation, burning, dull, aching, constant
-Dyspnea, pallor, tachycardia, anxiety and fear, indigestion, nausea, vomiting, upper back pain
-ECG changes: *T-wave inversion and depressed ST segments* (*inverted T-wave = myocardial
ischemia*)
*Treatment*:
-*Nitroglycerin*: goal is to reduce oxygen demand and increased oxygen supply to the myocardium
-*Organic nitrates*: short and long-term forms, used to treat acute angina attacks and prevent angina
*Nursing interventions*:
-know when the angina is happening
-decrease demands of O2 needed on the heart
-increase effectiveness of medication
-reduce anxiety
-patient should *stop all activity and sit and rest* in bed (*semi-fowler position*)
-*administer oxygen* 2 L/min through nasal cannula
-assess patients *pain, vital signs, RR*
-*Tell patient to carry nitroglycerin at all times*
Stable angina - correct answer--Most common type
-Chest pain that occurs when a person is *active or under severe stress* (cold, etc.)
-Usually *subsides with rest*
-*Treatment*: nitrates, reducing stress/activity
*Clinical Manifestations*: angina that usually occurs when work of the heart increased by physical
exertion: physical activity, emotion, stress, eating a heavy meal, exposure to cold
Unstable angina - correct answer--Angina that is *not relieved with rest*
-Requires *medical intervention*
-Occurs with *increased frequency, severity, and duration*
-Pain occurs with decreasing level of activity or stress
-May occur when the patient is just resting
-Patient is *at risk for myocardial infarction* (MI)
*Clinical manifestations*:
-*chest pains* during periods of rest or very little activity
Nitroglycerin - correct answer-*Short acting sublingual Nitroglycerin*:
-Drug of choice for treating acute angina
-Takes effect in *1-2 minutes*
,-Decreases myocardial workload and oxygen demand
-Make sure no lesions/abrasions under the tongue that could effect absorption
-*Do not swallow*: could cause medicine to lose its effectiveness if it enters the stomach
-*1 sublingual tablet* dissolved under the tongue or in the buccal pouch as soon as angina begins.
*Repeat every 5 minutes*, if needed, to a *maximum of three doses* within a 15-minute period. Client
must *call for medical assistance* if angina is not relieved after third dose
*Longer acting Nitroglycerin prep*:
-comes in an oral tablet, ointment, or transdermal patches
-used to *prevent* angina attacks—*NOT to treat acute* attacks
-main problem is *development of tolerance*
-*nitrate free periods* can limit tolerance by scheduling with a period of *8-10 hrs* per day
-scheduled to give *at night* when patient is less likely to experience angina
*Transbuccal administration*:
-Check the inside of the patients cheek to make sure there are *no ulcerations or abrasions* that could
interfere with the absorption of the drug
-Have the patient *place between gums and cheek* until full absorbed
-Do not swallow
-*Rotate from side to side with each dose*
*Transdermal administration*:
-discuss the administration with the patient
-make sure the patient knows to *take off old transdermal patches and wash the area before replacing a
new one* to prevent severe hypotension
-inform patients that they should *label in big writing their tubes* to prevent someone (or themselves)
from using it as hand lotion which would cause drug toxicity
*Headache is common side effect for both long and short acting nitrates*
Cardiomyopathy - correct answer--a disease that affects the heart muscle and its ability to *pump*
effectively
-Heart is *enlarged* and the walls become *thick and rigid*
*Complications*: Heart becomes weaker and has a *hard time pumping blood* leading to *heart failure
and dysrhythmias*
*Causes*:
-*Acquired*: develops from another disease
-*Inherited*: results from genetic conditions passed from parent to the child
-*Idiopathic*: unknown why it happens
*Diagnostic tests*:
-*Echocardiography*: to measure the *ejection fraction*
-*Chest X-ray*: to see enlargement of heart
-*Cardiac catheterization*: to view inside the heart
*Management*:
*Pharmacological therapy*:
,-Ace inhibitors, calcium channel blockers, beta blockers, Digoxin (*slow the HR down*)
-*Digoxin*: monitor for hyper-contractile pump
*Surgical options*:
-*Heart transplant*: is the *only cure for dilated* cardiomyopathy (DCM)
-*Left ventricular assistive devices (LVads)*: these can increase the patients *cardiac output* while they
wait for a heart donor; it's an *electrical pump surgically implanted* in the abdominal cavity; aid in
perfusion; patient needs to be *hooked up to a power source* the entire time
-*Pacemakers or ICDs* (implantable cardioverter defibrillator)
Dilated Cardiomyopathy (DCM) - correct answer--Most common
-Ventricular *enlargement*
-*Reduced ejection fraction* (EF) due to diastolic and systolic volumes increasing
-*Risk Factors*: Men, genetics
-*S/S*: dyspnea, fatigue, weakness, *edema*, *S3 & S4* (you'll hear both), dysrhythmias
-Overtime *causes heart failure* because the muscle becomes weaker
-*Clinical manifestations*: shortness of breath, fatigue, and *swelling of the lower extremities*, *JVD*
-Happens *gradually*, some patients are *asymptomatic*
Hypertrophic Cardiomyopathy (HCM) - correct answer--Decreased appliance of the *left ventricle* and
*hypertrophy* of the *ventricular muscle mass*
-Heart muscle becomes *really thick*—which decreases hearts ability to pump effectively
-*Impaired ventricular filling* because the ventricle is smaller due to how thick the heart is
-*S/S*: dyspnea, fatigue, weakness, *syncope* (loss of consciousness), dizziness, *S4*, dysrhythmias
-a *cardinal symptom* of HCM is a *harsh systolic injection murmur*
-*Clinical manifestations*: patient will have *angina*, chest pain, ischemia, may have AFIB
-Symptoms are going to develop when they are doing *physical activity because oxygen demand is
increased*
Coronary Artery Disease (CAD) - correct answer--Most common type of heart disease
-*Number 1 cause of death in men and women*
-caused by *impaired blood flow to the myocardium* and is usually due to *atherosclerotic plaque* in
the coronary arteries
-*Coronary atherosclerosis* most common cause of reduced coronary blood flow
*Risk factors*:
-*Elevated LDL* "bad cholesterol"
-*Metabolic syndrome* (cluster condition that increases risk for heart disease, stroke, diabetes)
-Eventually causes temporary/reversible *myocardial ischemia*
*Clinical manifestations*:
-Usually asymptomatic
-Most common manifestations are *angina pectoris* and *myocardial infarction* (MI)
*Complications*:
, -*Angina* pectoris (ischemia)
-*Acute coronary syndrome*
-*Myocardial infarction*
-Dysrhythmias
-Heart failure
-Sudden cardiac death
*Labs*:
-Cholesterol levels (HDL, LDL)
-Glucose levels
-Blood lipids and lipid protein levels
*Education for Patient*:
-*Diet*: high in fruits, vegetables, whole grains and unsaturated fatty acids
-*Exercise*: at least for 30 minutes a day
-*BMI*: less than 30, anything above is obesity, look at fat distribution
-Smoking cessation
-Controlling HTN
-Controlling diabetes
-Controlling their hyperlipidemia (LDL and HDL levels)
*Medications*:
-3-hydroxy-3-methylglutaryl coenzyme A (*STATINs*)
-*Nicotinic acids*
-Fibric acids (*fibrates*)
-Bile acid sequestrants (*resins*)
-Cholesterol absorption inhibitors
-*Omega-3 acid ethyl esters*
Cholesterol/Lipid lab values - correct answer--*Total cholesterol*: normal levels *<200 mg/dL*
-*LDLs* (less desirable lipoproteins): deposit cholesterol on the arterial walls; normal levels *<100
mg/dL*
-*HDLs* (highly desirable lipoproteins): help clear cholesterol from the arteries, so it is transported to
the liver to be excreted; normal levels (*male: >40 mg/dL*, *female: >50 mg/dL*)
-levels *greater than 60 for HDL* have a *protective effect* and *reduce the risk of CAD*, optimal level
less than 100
-*Triglycerides*: body fat, normal levels *<150 mg/dL*
Cardiac enzyme lab values - correct answer-*Troponin T*: normal *< 0.2 mcg/L*; elevated troponin =
*cardiac cells damaged*
*Creatinine Kinase (CK-MB)*: normal is *5 to 25 IU/L*; elevated CK-MB = *indicates MI*
Electrolyte lab values - correct answer-*Potassium* (K+): normal *3.5-5.0* mEq/L
*Magnesium* (Mg 2+): normal *1.8-3.0* mg/dL
*Calcium* (Ca 2+): normal *8.5-10.5* mg/dL
Questions with simplified correct
Answers
Angina - correct answer--chest pain brought about by *myocardial ischemia*
*Manifestations:*
-*Chest Pain*: substernal, precordial, may *radiate to neck/arms/shoulders or jaw*
-Usually lasts *2-5 minutes*
-Quality: tight, squeezing, constricting, heavy sensation, burning, dull, aching, constant
-Dyspnea, pallor, tachycardia, anxiety and fear, indigestion, nausea, vomiting, upper back pain
-ECG changes: *T-wave inversion and depressed ST segments* (*inverted T-wave = myocardial
ischemia*)
*Treatment*:
-*Nitroglycerin*: goal is to reduce oxygen demand and increased oxygen supply to the myocardium
-*Organic nitrates*: short and long-term forms, used to treat acute angina attacks and prevent angina
*Nursing interventions*:
-know when the angina is happening
-decrease demands of O2 needed on the heart
-increase effectiveness of medication
-reduce anxiety
-patient should *stop all activity and sit and rest* in bed (*semi-fowler position*)
-*administer oxygen* 2 L/min through nasal cannula
-assess patients *pain, vital signs, RR*
-*Tell patient to carry nitroglycerin at all times*
Stable angina - correct answer--Most common type
-Chest pain that occurs when a person is *active or under severe stress* (cold, etc.)
-Usually *subsides with rest*
-*Treatment*: nitrates, reducing stress/activity
*Clinical Manifestations*: angina that usually occurs when work of the heart increased by physical
exertion: physical activity, emotion, stress, eating a heavy meal, exposure to cold
Unstable angina - correct answer--Angina that is *not relieved with rest*
-Requires *medical intervention*
-Occurs with *increased frequency, severity, and duration*
-Pain occurs with decreasing level of activity or stress
-May occur when the patient is just resting
-Patient is *at risk for myocardial infarction* (MI)
*Clinical manifestations*:
-*chest pains* during periods of rest or very little activity
Nitroglycerin - correct answer-*Short acting sublingual Nitroglycerin*:
-Drug of choice for treating acute angina
-Takes effect in *1-2 minutes*
,-Decreases myocardial workload and oxygen demand
-Make sure no lesions/abrasions under the tongue that could effect absorption
-*Do not swallow*: could cause medicine to lose its effectiveness if it enters the stomach
-*1 sublingual tablet* dissolved under the tongue or in the buccal pouch as soon as angina begins.
*Repeat every 5 minutes*, if needed, to a *maximum of three doses* within a 15-minute period. Client
must *call for medical assistance* if angina is not relieved after third dose
*Longer acting Nitroglycerin prep*:
-comes in an oral tablet, ointment, or transdermal patches
-used to *prevent* angina attacks—*NOT to treat acute* attacks
-main problem is *development of tolerance*
-*nitrate free periods* can limit tolerance by scheduling with a period of *8-10 hrs* per day
-scheduled to give *at night* when patient is less likely to experience angina
*Transbuccal administration*:
-Check the inside of the patients cheek to make sure there are *no ulcerations or abrasions* that could
interfere with the absorption of the drug
-Have the patient *place between gums and cheek* until full absorbed
-Do not swallow
-*Rotate from side to side with each dose*
*Transdermal administration*:
-discuss the administration with the patient
-make sure the patient knows to *take off old transdermal patches and wash the area before replacing a
new one* to prevent severe hypotension
-inform patients that they should *label in big writing their tubes* to prevent someone (or themselves)
from using it as hand lotion which would cause drug toxicity
*Headache is common side effect for both long and short acting nitrates*
Cardiomyopathy - correct answer--a disease that affects the heart muscle and its ability to *pump*
effectively
-Heart is *enlarged* and the walls become *thick and rigid*
*Complications*: Heart becomes weaker and has a *hard time pumping blood* leading to *heart failure
and dysrhythmias*
*Causes*:
-*Acquired*: develops from another disease
-*Inherited*: results from genetic conditions passed from parent to the child
-*Idiopathic*: unknown why it happens
*Diagnostic tests*:
-*Echocardiography*: to measure the *ejection fraction*
-*Chest X-ray*: to see enlargement of heart
-*Cardiac catheterization*: to view inside the heart
*Management*:
*Pharmacological therapy*:
,-Ace inhibitors, calcium channel blockers, beta blockers, Digoxin (*slow the HR down*)
-*Digoxin*: monitor for hyper-contractile pump
*Surgical options*:
-*Heart transplant*: is the *only cure for dilated* cardiomyopathy (DCM)
-*Left ventricular assistive devices (LVads)*: these can increase the patients *cardiac output* while they
wait for a heart donor; it's an *electrical pump surgically implanted* in the abdominal cavity; aid in
perfusion; patient needs to be *hooked up to a power source* the entire time
-*Pacemakers or ICDs* (implantable cardioverter defibrillator)
Dilated Cardiomyopathy (DCM) - correct answer--Most common
-Ventricular *enlargement*
-*Reduced ejection fraction* (EF) due to diastolic and systolic volumes increasing
-*Risk Factors*: Men, genetics
-*S/S*: dyspnea, fatigue, weakness, *edema*, *S3 & S4* (you'll hear both), dysrhythmias
-Overtime *causes heart failure* because the muscle becomes weaker
-*Clinical manifestations*: shortness of breath, fatigue, and *swelling of the lower extremities*, *JVD*
-Happens *gradually*, some patients are *asymptomatic*
Hypertrophic Cardiomyopathy (HCM) - correct answer--Decreased appliance of the *left ventricle* and
*hypertrophy* of the *ventricular muscle mass*
-Heart muscle becomes *really thick*—which decreases hearts ability to pump effectively
-*Impaired ventricular filling* because the ventricle is smaller due to how thick the heart is
-*S/S*: dyspnea, fatigue, weakness, *syncope* (loss of consciousness), dizziness, *S4*, dysrhythmias
-a *cardinal symptom* of HCM is a *harsh systolic injection murmur*
-*Clinical manifestations*: patient will have *angina*, chest pain, ischemia, may have AFIB
-Symptoms are going to develop when they are doing *physical activity because oxygen demand is
increased*
Coronary Artery Disease (CAD) - correct answer--Most common type of heart disease
-*Number 1 cause of death in men and women*
-caused by *impaired blood flow to the myocardium* and is usually due to *atherosclerotic plaque* in
the coronary arteries
-*Coronary atherosclerosis* most common cause of reduced coronary blood flow
*Risk factors*:
-*Elevated LDL* "bad cholesterol"
-*Metabolic syndrome* (cluster condition that increases risk for heart disease, stroke, diabetes)
-Eventually causes temporary/reversible *myocardial ischemia*
*Clinical manifestations*:
-Usually asymptomatic
-Most common manifestations are *angina pectoris* and *myocardial infarction* (MI)
*Complications*:
, -*Angina* pectoris (ischemia)
-*Acute coronary syndrome*
-*Myocardial infarction*
-Dysrhythmias
-Heart failure
-Sudden cardiac death
*Labs*:
-Cholesterol levels (HDL, LDL)
-Glucose levels
-Blood lipids and lipid protein levels
*Education for Patient*:
-*Diet*: high in fruits, vegetables, whole grains and unsaturated fatty acids
-*Exercise*: at least for 30 minutes a day
-*BMI*: less than 30, anything above is obesity, look at fat distribution
-Smoking cessation
-Controlling HTN
-Controlling diabetes
-Controlling their hyperlipidemia (LDL and HDL levels)
*Medications*:
-3-hydroxy-3-methylglutaryl coenzyme A (*STATINs*)
-*Nicotinic acids*
-Fibric acids (*fibrates*)
-Bile acid sequestrants (*resins*)
-Cholesterol absorption inhibitors
-*Omega-3 acid ethyl esters*
Cholesterol/Lipid lab values - correct answer--*Total cholesterol*: normal levels *<200 mg/dL*
-*LDLs* (less desirable lipoproteins): deposit cholesterol on the arterial walls; normal levels *<100
mg/dL*
-*HDLs* (highly desirable lipoproteins): help clear cholesterol from the arteries, so it is transported to
the liver to be excreted; normal levels (*male: >40 mg/dL*, *female: >50 mg/dL*)
-levels *greater than 60 for HDL* have a *protective effect* and *reduce the risk of CAD*, optimal level
less than 100
-*Triglycerides*: body fat, normal levels *<150 mg/dL*
Cardiac enzyme lab values - correct answer-*Troponin T*: normal *< 0.2 mcg/L*; elevated troponin =
*cardiac cells damaged*
*Creatinine Kinase (CK-MB)*: normal is *5 to 25 IU/L*; elevated CK-MB = *indicates MI*
Electrolyte lab values - correct answer-*Potassium* (K+): normal *3.5-5.0* mEq/L
*Magnesium* (Mg 2+): normal *1.8-3.0* mg/dL
*Calcium* (Ca 2+): normal *8.5-10.5* mg/dL
