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Questions and Answers

Which foods should be limited or avoided to lower cholesterol levels?

  • Eggs, whole milk, red meat (correct)
  • Pasta, chicken, whole wheat
  • Salmon, olive oil, potatoes
  • Spinach, baked beans, corn

    • What assessment finding is associated with decreased cardiac output?

  • Elevated blood pressure
  • Increased energy levels
  • Weak, rapid pulse (correct)
  • Stable heart rate

    • What is an ideal INR range for a patient on warfarin therapy?

  • 0.8-1.2
  • 1.5-2.0
  • 0.5-1.0
  • 2.0-3.0 (correct)

    • What is the normal blood pressure reading for an adult?

    <p>120/80 (D)</p> Signup and view all the answers

    Which of the following is a recommended method to check blood pressure accurately?

    <p>Resting for at least 5 minutes before measuring (D)</p> Signup and view all the answers

    What cardiac biomarker remains elevated for 7-10 days after myocardial injury?

    <p>Troponin (B)</p> Signup and view all the answers

    Which symptom is NOT typically associated with decreased cardiac output?

    <p>Hyperactivity (A)</p> Signup and view all the answers

    What is the effect of elevated total cholesterol levels above 200 mg/dL?

    <p>Increased risk of heart disease (B)</p> Signup and view all the answers

    Which lead placement for an electrocardiogram is correctly matched?

    <p>V4: 5th intercostal space, left mid-clavicular line (C)</p> Signup and view all the answers

    What is the most common type of cardiomyopathy?

    <p>Dilated cardiomyopathy (D)</p> Signup and view all the answers

    Which of the following is a sign of endocarditis?

    <p>Petechiae (C)</p> Signup and view all the answers

    What complication is associated with pericarditis?

    <p>Cardiac tamponade (C)</p> Signup and view all the answers

    What treatment is most commonly used for deep vein thrombosis?

    <p>Anticoagulants (C)</p> Signup and view all the answers

    Which symptom is indicative of cardiac failure as a complication of endocarditis?

    <p>Edema (A)</p> Signup and view all the answers

    Which of the following findings is a direct indicator of a potential cardiovascular problem?

    <p>Dyspnea on exertion (C)</p> Signup and view all the answers

    What is the primary purpose of a Holter monitor in the context of cardiovascular assessment?

    <p>To monitor the heart's activity continuously for extended periods (C)</p> Signup and view all the answers

    Which of the following is a crucial pre-procedure instruction for a client scheduled for a cardiac catheterization?

    <p>Limit fluid intake for 6-8 hours before the procedure (C)</p> Signup and view all the answers

    Which of the following assessments is not a component of a neurovascular check after a cardiac catheterization?

    <p>Assessing the patient's orientation and cognitive function (B)</p> Signup and view all the answers

    What is the primary purpose of a stress test in evaluating cardiovascular health?

    <p>To assess the heart's function under physical stress (D)</p> Signup and view all the answers

    What is the most important reason for monitoring the neurovascular status of a client after a cardiac catheterization?

    <p>To identify any potential complications related to the procedure (D)</p> Signup and view all the answers

    Which of the following statements accurately describes a heart murmur?

    <p>A whooshing sound caused by turbulent blood flow through a valve (D)</p> Signup and view all the answers

    What should a nurse do if the potassium level is 3.2 mEq/L before administering hydrochlorothiazide?

    <p>Hold hydrochlorothiazide and inform the healthcare provider. (C)</p> Signup and view all the answers

    What is a critical parameter for administering digoxin?

    <p>Pulse rate above 60 beats per minute. (B)</p> Signup and view all the answers

    Which action should the nurse take when the blood pressure is 118/64 mm Hg?

    <p>Administer antihypertensive medication as prescribed. (C)</p> Signup and view all the answers

    What dietary precaution should a patient on warfarin follow?

    <p>Consume consistent amounts of vitamin K. (A)</p> Signup and view all the answers

    What is a common complication associated with valve disorders?

    <p>Endocarditis. (D)</p> Signup and view all the answers

    What is a unique characteristic of mechanical valve replacements?

    <p>They are durable but need lifelong anticoagulation. (A)</p> Signup and view all the answers

    Which medication increases the risk of bleeding for patients on warfarin?

    <p>Ibuprofen. (D)</p> Signup and view all the answers

    Which symptom is commonly associated with valve disorders?

    <p>Palpitations. (C)</p> Signup and view all the answers

    What precaution should patients on warfarin take regarding dental care?

    <p>Use a soft toothbrush and electric razors. (B)</p> Signup and view all the answers

    What is a necessary action before administering antihypertensives?

    <p>Measure blood pressure. (D)</p> Signup and view all the answers

    What does a drop in blood pressure, an increase in pulse, and dizziness indicate?

    <p>Orthostatic hypotension (B)</p> Signup and view all the answers

    Which of the following is considered a non-modifiable risk factor for hypertension?

    <p>Family history (D)</p> Signup and view all the answers

    Which complication is most commonly associated with untreated hypertension?

    <p>Vision loss (A)</p> Signup and view all the answers

    When taking orthostatic vital signs, which sequence is recommended?

    <p>Supine, seated, standing (D)</p> Signup and view all the answers

    When should the nurse instruct the UAP to wait between taking orthostatic blood pressure measurements?

    <p>One to two minutes (B)</p> Signup and view all the answers

    Which instruction is important for patient teaching regarding hypertension medications?

    <p>Do not stop medications abruptly (D)</p> Signup and view all the answers

    What is the recommended action regarding anticoagulants before cardiac surgery?

    <p>Hold for up to a week before surgery (A)</p> Signup and view all the answers

    For which condition should pulse and blood pressure be checked before administering medications?

    <p>Beta-blockers and calcium channel blockers (C)</p> Signup and view all the answers

    Which is a lifestyle modification to help manage hypertension?

    <p>Regular physical activity (D)</p> Signup and view all the answers

    Which group has the highest risk for hypertension according to ethnicity?

    <p>Non-Hispanic blacks (C)</p> Signup and view all the answers

    Study Notes

    Cardiac Exam Review - May 2024

    • Cardiovascular Problems: Chest pain, heart murmurs (valve disorders), dyspnea on exertion, dizziness, poikilothermia (peripheral arterial disease), orthostatic hypotension, dependent rubor, edema

    Diagnostic Tests

    • Stress Test: NPO 2-4 hours, no smoking/caffeine, comfortable clothing, walking
    • EKG (ECG): Lie still, normal breathing, accurate lead placement, clean/dry skin
    • Holter Monitor: 24-72 hour continuous monitoring (for low risk, intermittent symptoms)
    • Echocardiography: Shows heart motion
    • Duplex Ultrasound: Shows blood flow through arteries and veins, identifies blockages
    • Cardiac Catheterization/Angioplasty: Check for prior contrast dye reactions, invasive, signed consent needed, NPO 6-8 hours, local anesthesia, warm/flushed feeling, post-op: increase fluids, maintain bedrest, pressure dressing, monitor neurovascular status (circulation, motion, sensation), vital signs, heart rate, rhythm, no flexion of extremity

    Patient Teaching for Hypertension

    • Take medications as directed, do not stop abruptly
    • Take meds even if BP is normal and feeling well
    • Decrease sodium
    • Monitor blood pressure
    • Check pulse and blood pressure before beta-blockers or calcium channel blockers
    • Change positions slowly to prevent orthostatic hypotension

    Cardiac Surgery

    • Hold anticoagulants up to a week before surgery
    • Hold diuretics for 24 hours before surgery
    • Diabetics should not take insulin or antidiabetic medications before surgery
    • Post-op: monitor vital signs, rhythm, urine output, and lung sounds
    • Sternotomy dressing changes under sterile technique
    • Medicate for pain before ambulation
    • Incentive spirometry

    Medications

    • Beta-blockers and calcium channel blockers: check pulse and blood pressure before administering, do not administer if pulse or BP is below 100mmHg systolic or 60 beats per minute
    • ACE inhibitors and other antihypertensives: check BP before administration
    • Digoxin: check pulse, hold if below parameter (usually 60 beats per minute)
    • Diuretics (Hydrochlorothiazide, furosemide, bumetanide): check potassium levels, hold if hypokalemic, Spironolactone can increase potassium
    • Give antihypertensives even if BP is normal
    • Warfarin: monitor PT, INR, consume consistent amounts of vitamin K (mostly green leafy vegetables), monitor for bleeding, no over-the-counter medications (Aspirin, NSAIDs) without consulting healthcare provider., bleeding precautions, don't go barefoot. Carry medical alert identification.

    Math

    • Cardiac output: stroke volume x heart rate, convert to liters per minute and round to the nearest 10th.
    • Drop factors (drops per minute): mL x drop factor/time (minutes)
    • Hourly rate (infusion runs less than an hour): mL x 60/time (minutes)
    • Hourly rate (infusion runs over an hour): mL x 60/time (hours)
    • Duration of infusions: mL to infuse/hourly rate
    • Volume (mL) to infuse/hourly rate

    Valve Disorders

    • Etiology: congenital, aging, endocarditis, rheumatic fever
    • Signs and symptoms: heart murmur, dysrhythmias, palpitations, chest pain
    • Complications: heart failure, stroke, endocarditis
    • Interventions: medications to manage dysrhythmias and heart failure, prevent stroke; valve repair or replacement
    • Valve replacement: Biologic (lasts 7-10 years, no anticoagulant required), Mechanical (durable, lifelong anticoagulation required)

    NCLEX Question

    • Which finding is common to all valve disorders? Heart murmur

    Endocarditis

    • Risk factors: valve disorders, IV drug use, gum disease, prior endocarditis, and rheumatic fever
    • Signs and symptoms: heart murmur, fever, malaise, petechiae, Janeway lesions, Osler's nodes, splinter hemorrhages
    • Treatment: antibiotics for several weeks (intravenous penicillin most often)
    • Complications: heart failure, valve dysfunction, and stroke

    Pericarditis

    • Inflammation of pericardial lining
    • Signs and symptoms: pleuritic chest pain (sharp, heavy, worse when coughing, better when sitting up & leaning forward), friction rub, dyspnea
    • Complications: heart failure, cardiac tamponade (jugular venous distention, tachycardia, hypotension, muffled heart sounds)

    Cardiomegaly

    • Enlargement of the heart
    • Types: Dilated (most common, stretched & less contractile), Restrictive (rigid walls, don't expand/contract normally), Hypertrophic (enlarged heart muscle, decreasing volume).
    • Common etiologies: hypertension, pregnancy, alcoholism
    • All types can cause heart failure

    Deep Vein Thrombosis (DVT)

    • Clots in a vein
    • Risk factors: venous stasis (immobility), oral contraceptives, smoking, vessel injury, hyper-coagulability (dehydration)
    • Signs & symptoms: redness, warmth, edema, pain, hard (indurated) distended vein
    • Treatment: anticoagulants, compression stockings, elevation of leg above heart, warm compresses
    • Complications: pulmonary embolism, recurrent DVTs, venous insufficiency

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