NR 661 Cardiovascular final Exam Review |
Complete
Study Pack with Verified Questions, Correct
Answers | Advanced Cardiac Nursing Guide
ALL QUESTIONS WITH ANSWERS
A patient has had poorly controlled hypertension for more than 10 years.
Indicate the most likely position of his point of maximal impulse (PMI)
a. 5th intercostal space (ICS) midclavicular line (MCL)
b. 8th ICS MCL
c. 5th ICS, left of MCL
d. 6th ICS, right of MCL
CORRECT ANS-c. 5th ICS, left of MCL
,Expert Rationale
Chronic poorly controlled hypertension leads to left ventricular
hypertrophy (LVH) as the left ventricle works against persistently elevated
afterload. Over time, this causes the left ventricle to enlarge and
hypertrophy, resulting in a downward and lateral displacement of the
point of maximal impulse (PMI). Normally, the PMI is located at the 5th
intercostal space at the midclavicular line. With LVH, the PMI shifts to the
left of the midclavicular line, and in severe cases, may also move
downward to the 6th intercostal space. Option A describes the normal
PMI location, which would not be expected in a patient with long-standing
poorly controlled hypertension. Option B (8th ICS MCL) is too far inferior
and would suggest severe cardiomegaly or other pathology. Option D (6th
ICS, right of MCL) is incorrect because the PMI is a left-sided finding; a
right-sided PMI would suggest dextrocardia or other anatomical
anomalies. The displacement of the PMI is a valuable clinical marker of
cardiac remodeling and should prompt aggressive blood pressure
management to prevent progression to heart failure.
DIF: Cognitive Level: Apply (Application) TOP: Cardiovascular Assessment
MSC: NCLEX: Physiological Integrity
Valve most commonly involved in chronic rheumatic heart disease is the:
a. aortic
b. mitral
c. pulmonic
d. tricuspid
CORRECT ANS-b. mitral
Expert Rationale
Rheumatic heart disease is a complication of acute rheumatic fever, which
itself results from an autoimmune response to group A streptococcal
,pharyngitis. The mitral valve is the most frequently affected valve in
chronic rheumatic heart disease, involved in approximately 60–80% of
cases. The inflammatory process causes thickening, fibrosis, and fusion of
the valve leaflets and chordae tendineae, leading to mitral stenosis and/or
mitral regurgitation. The aortic valve is the second most commonly
affected, often in combination with mitral valve involvement. The
pulmonic and tricuspid valves are much less frequently involved in
rheumatic heart disease. The pathophysiological mechanism involves
molecular mimicry, where antibodies directed against streptococcal M
proteins cross-react with cardiac myosin and valvular endothelium,
resulting in chronic valvular damage. Patients with a history of rheumatic
fever require lifelong antibiotic prophylaxis for dental and surgical
procedures to prevent infective endocarditis. Early recognition and
management of streptococcal pharyngitis with appropriate antibiotics
remain the primary preventive strategy.
DIF: Cognitive Level: Remember (Knowledge) TOP: Cardiovascular
Disorders MSC: NCLEX: Physiological Integrity
A 50 year old patient with Hypertension has taken hydrochlorothiazide
25 mg daily for the past 4 weeks. How should the nurse practitioner
proceed? BP-155/95; 145/90
a. wait 4 weeks before making a dosage change
b. increase the hydrochlorothiazide to 50mg daily
c. add a drug from another class to the daily 25 mg hydrochlorothiazide
d. stop the hydrochlorothiazide and start a drug from a different class
CORRECT ANS-c. add a drug from another class to the daily 25 mg
hydrochlorothiazide
Expert Rationale
According to the JNC 8 and ACC/AHA hypertension guidelines, if a patient's
, blood pressure remains above target after 4 weeks of monotherapy at a
moderate dose, the next step is to either increase the dose of the current
medication or add a second agent from a different class. In this case, the
patient has been on hydrochlorothiazide 25 mg daily for 4 weeks, yet the
blood pressure remains elevated at 145/90 (though improved from
155/95). The optimal approach is to add a drug from another class, such
as an ACE inhibitor, ARB, or calcium channel blocker, rather than increasing
the thiazide dose to 50 mg. Higher doses of thiazides are associated with
greater metabolic side effects (hypokalemia, hyperglycemia,
hyperuricemia) without significantly greater antihypertensive efficacy due
to a flat dose-response curve. Option A (waiting another 4 weeks) is not
appropriate because the patient has already been on the medication for
an adequate trial period. Option B (increasing to 50 mg) is less preferred
due to increased adverse effects. Option D (stopping and switching
classes) is not indicated when the current agent has shown some efficacy
and is well-tolerated. Combination therapy is often necessary to achieve
target blood pressure goals.
DIF: Cognitive Level: Apply (Application) TOP: Hypertension Management
MSC: NCLEX: Pharmacological and Parenteral Therapies
Which choice below would be the best choice for an 80-year old patient
whose blood pressure is 172/72
a. chlorthalidone
b. amlodipine
c. monopril
d. acebutolol
CORRECT ANS-b. amlodipine
Expert Rationale
In an 80-year-old patient with isolated systolic hypertension (elevated
Complete
Study Pack with Verified Questions, Correct
Answers | Advanced Cardiac Nursing Guide
ALL QUESTIONS WITH ANSWERS
A patient has had poorly controlled hypertension for more than 10 years.
Indicate the most likely position of his point of maximal impulse (PMI)
a. 5th intercostal space (ICS) midclavicular line (MCL)
b. 8th ICS MCL
c. 5th ICS, left of MCL
d. 6th ICS, right of MCL
CORRECT ANS-c. 5th ICS, left of MCL
,Expert Rationale
Chronic poorly controlled hypertension leads to left ventricular
hypertrophy (LVH) as the left ventricle works against persistently elevated
afterload. Over time, this causes the left ventricle to enlarge and
hypertrophy, resulting in a downward and lateral displacement of the
point of maximal impulse (PMI). Normally, the PMI is located at the 5th
intercostal space at the midclavicular line. With LVH, the PMI shifts to the
left of the midclavicular line, and in severe cases, may also move
downward to the 6th intercostal space. Option A describes the normal
PMI location, which would not be expected in a patient with long-standing
poorly controlled hypertension. Option B (8th ICS MCL) is too far inferior
and would suggest severe cardiomegaly or other pathology. Option D (6th
ICS, right of MCL) is incorrect because the PMI is a left-sided finding; a
right-sided PMI would suggest dextrocardia or other anatomical
anomalies. The displacement of the PMI is a valuable clinical marker of
cardiac remodeling and should prompt aggressive blood pressure
management to prevent progression to heart failure.
DIF: Cognitive Level: Apply (Application) TOP: Cardiovascular Assessment
MSC: NCLEX: Physiological Integrity
Valve most commonly involved in chronic rheumatic heart disease is the:
a. aortic
b. mitral
c. pulmonic
d. tricuspid
CORRECT ANS-b. mitral
Expert Rationale
Rheumatic heart disease is a complication of acute rheumatic fever, which
itself results from an autoimmune response to group A streptococcal
,pharyngitis. The mitral valve is the most frequently affected valve in
chronic rheumatic heart disease, involved in approximately 60–80% of
cases. The inflammatory process causes thickening, fibrosis, and fusion of
the valve leaflets and chordae tendineae, leading to mitral stenosis and/or
mitral regurgitation. The aortic valve is the second most commonly
affected, often in combination with mitral valve involvement. The
pulmonic and tricuspid valves are much less frequently involved in
rheumatic heart disease. The pathophysiological mechanism involves
molecular mimicry, where antibodies directed against streptococcal M
proteins cross-react with cardiac myosin and valvular endothelium,
resulting in chronic valvular damage. Patients with a history of rheumatic
fever require lifelong antibiotic prophylaxis for dental and surgical
procedures to prevent infective endocarditis. Early recognition and
management of streptococcal pharyngitis with appropriate antibiotics
remain the primary preventive strategy.
DIF: Cognitive Level: Remember (Knowledge) TOP: Cardiovascular
Disorders MSC: NCLEX: Physiological Integrity
A 50 year old patient with Hypertension has taken hydrochlorothiazide
25 mg daily for the past 4 weeks. How should the nurse practitioner
proceed? BP-155/95; 145/90
a. wait 4 weeks before making a dosage change
b. increase the hydrochlorothiazide to 50mg daily
c. add a drug from another class to the daily 25 mg hydrochlorothiazide
d. stop the hydrochlorothiazide and start a drug from a different class
CORRECT ANS-c. add a drug from another class to the daily 25 mg
hydrochlorothiazide
Expert Rationale
According to the JNC 8 and ACC/AHA hypertension guidelines, if a patient's
, blood pressure remains above target after 4 weeks of monotherapy at a
moderate dose, the next step is to either increase the dose of the current
medication or add a second agent from a different class. In this case, the
patient has been on hydrochlorothiazide 25 mg daily for 4 weeks, yet the
blood pressure remains elevated at 145/90 (though improved from
155/95). The optimal approach is to add a drug from another class, such
as an ACE inhibitor, ARB, or calcium channel blocker, rather than increasing
the thiazide dose to 50 mg. Higher doses of thiazides are associated with
greater metabolic side effects (hypokalemia, hyperglycemia,
hyperuricemia) without significantly greater antihypertensive efficacy due
to a flat dose-response curve. Option A (waiting another 4 weeks) is not
appropriate because the patient has already been on the medication for
an adequate trial period. Option B (increasing to 50 mg) is less preferred
due to increased adverse effects. Option D (stopping and switching
classes) is not indicated when the current agent has shown some efficacy
and is well-tolerated. Combination therapy is often necessary to achieve
target blood pressure goals.
DIF: Cognitive Level: Apply (Application) TOP: Hypertension Management
MSC: NCLEX: Pharmacological and Parenteral Therapies
Which choice below would be the best choice for an 80-year old patient
whose blood pressure is 172/72
a. chlorthalidone
b. amlodipine
c. monopril
d. acebutolol
CORRECT ANS-b. amlodipine
Expert Rationale
In an 80-year-old patient with isolated systolic hypertension (elevated
