Intro To Med Surg Wk10

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Questions and Answers

Which of the following physiological responses is most likely to occur as a direct result of decreased preload?

  • Postural hypotension due to a reduction in cardiac output (correct)
  • Elevated blood pressure as the heart works harder to pump blood
  • Increased cardiac output to compensate for reduced ventricular filling
  • Increased ejection fraction to maintain adequate stroke volume

Where is the apical pulse, also known as the point of maximal impulse, typically auscultated?

  • Fourth intercostal space, left sternal border
  • Second intercostal space, left sternal border
  • Fifth intercostal space, midclavicular line (correct)
  • Second intercostal space, right sternal border

How does hypoxemia affect cardiac function, and what is the most significant consequence?

  • Enhances cardiac output by stimulating the sympathetic nervous system
  • Suppresses cardiac contractility, potentially decreasing stroke volume and cardiac output (correct)
  • Increases myocardial contractility, leading to hypertension
  • Improves cardiac contractility through increased oxygen delivery to myocardial cells

Which ejection fraction percentage is most indicative of impaired left ventricular function?

<p>30% (D)</p> Signup and view all the answers

Which physiological change in older adults is associated with decreased estrogen levels and altered cardiovascular dynamics?

<p>Vasoconstriction and reduced coronary blood flow due to declining estrogen levels (D)</p> Signup and view all the answers

Which assessment parameters should be included when evaluating changes in arterial blood flow? (Select all that apply)

<p>Paresthesia and paralysis (A), Pain and pallor (B), Capillary refill (C), Poikilothermia/polar and pulselessness (D)</p> Signup and view all the answers

What does pulse pressure (systolic minus diastolic) primarily reflect?

<p>Stroke volume and cardiac output (A)</p> Signup and view all the answers

During auscultation, where should you listen to assess the pulmonic valve area?

<p>Second intercostal space, left of the sternum (A)</p> Signup and view all the answers

How do changes in fluid volume affect blood pressure, and what conditions can arise from these changes?

<p>Changes in fluid volume affect blood volume and can contribute to either hypotension or hypertension (C)</p> Signup and view all the answers

What is the significance of an elevated brain natriuretic peptide (BNP) level greater than 100 pg/mL?

<p>Suggests the presence of heart failure (C)</p> Signup and view all the answers

A patient with angina reports that their chest pain now occurs even at rest and is not relieved by nitroglycerin. What type of angina is the patient most likely experiencing?

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

Why is it important to assess blood pressure prior to administering vasodilators to a patient with a cardiovascular condition?

<p>To detect existing hypotension, which could be exacerbated by vasodilators. (C)</p> Signup and view all the answers

A patient's lab results show a potassium level of 2.8 mEq/L. Which ECG finding is most consistent with this electrolyte imbalance?

<p>Inverted T waves and a U wave (A)</p> Signup and view all the answers

A patient being treated for a myocardial infarction (MI) has a sudden decrease in blood pressure and muffled heart sounds post cardiac surgery. What complication should the nurse suspect?

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

A patient is prescribed a beta-blocker (metoprolol) for hypertension. What is an important consideration regarding the use of this medication for a patient with diabetes?

<p>Beta-blockers can mask the symptoms of hypoglycemia. (D)</p> Signup and view all the answers

What is the primary rationale for administering morphine to a patient experiencing a myocardial infarction?

<p>To reduce pain and decrease myocardial oxygen demand. (D)</p> Signup and view all the answers

Why are patients instructed to take bile acid sequestrants before meals?

<p>To maximize the drug's effectiveness in binding with cholesterol in the gastrointestinal tract. (B)</p> Signup and view all the answers

A patient with a history of liver disease is prescribed medication to improve their lipid profile. Which medication would be contraindicated?

<p>All of the above (D)</p> Signup and view all the answers

Which modifiable risk factor contributes most significantly to the development of coronary artery disease?

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

Following a percutaneous coronary intervention (PCI), a patient reports sudden onset chest pain and displays ST-segment elevation on their ECG. What immediate complication is most likely occurring?

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

Why is it critical to avoid abruptly discontinuing antihypertensive medications?

<p>To avoid an increased risk of rebound hypertension (B)</p> Signup and view all the answers

A patient taking spironolactone is also prescribed potassium supplements. Which electrolyte imbalance is the patient most at risk for?

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

Which of the following is a diagnostic criterion for hypertensive emergency?

<p>Blood pressure greater than 180/120 mmHg with evidence of target organ damage (D)</p> Signup and view all the answers

Which instruction should a nurse provide to a client scheduled to have their blood pressure measured?

<p>Rest with feet supported on the ground and refrain from smoking for 30 minutes before the measurement (A)</p> Signup and view all the answers

ACE inhibitors lower blood pressure via which primary mechanism?

<p>Preventing the conversion of angiotensin I to angiotensin II (A)</p> Signup and view all the answers

In a patient with hypertension, which set of organs are most susceptible to target organ damage?

<p>Brain, kidneys, and eyes (D)</p> Signup and view all the answers

How can beta-blockers potentially affect individuals with diabetes or asthma?

<p>By masking signs of hypoglycemia and worsening bronchoconstriction (D)</p> Signup and view all the answers

Which condition increases the risk of heart disease and is characterized by hypertension, hypercholesterolemia, and abdominal obesity?

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

A decrease in cardiac output can directly lead to which of the following life-threatening conditions?

<p>Organ failure (D)</p> Signup and view all the answers

What is the minimum bladder width required for accurate blood pressure measurement?

<p>40% of limb circumference (A)</p> Signup and view all the answers

Flashcards

Cardiac Output

Amount of blood that leaves the ventricles in one minute (4-6 liters).

Blood Pressure

Pressure exerted on arterial walls during systole and diastole, influenced by cardiac output and vascular resistance.

Pulse Pressure

Systolic minus diastolic pressure which is a Reflection of stroke volume and cardiac output.

BNP

Brain natriuretic peptide triggers sodium excretion that will result in a decrease in the volume of fluid.

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Wheezing

Narrowing of lower airways, often causing a whistling sound.

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Crackles

Fluid accumulation sounds typically auscultated in the lower bases of the lungs.

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Heart Failure Symptoms

Jugular vein distention, peripheral edema, hepatomegaly, shortness of breath, and crackles suggest increased pressure and filling volumes in the ventricles.

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Hypertension

Having a blood pressure greater than or equal to 140/90.

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Myocardial Ischemia/Infarct

Blockage or constriction of coronary arteries potentially leads to this.

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Sinoatrial (SA) Node

Initiates the impulse that causes atrial contraction, observed by a P wave on an EKG.

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Hypokalemia signs

Muscle weakness, fatigue, muscle cramps, constipation, inverted T waves, and a U wave on an EKG.

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Unstable Angina

Increases in severity and may not be relieved with rest or nitroglycerin.

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Angina pain location

Typically felt behind the sternum and may radiate to the neck, jaw, shoulders or left arm.

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Nitroglycerin Administration

Keep in a dark bottle, renew every 6 months, place under a moist tongue, and do not swallow. Take every 5 minutes up to 3 doses, call 911 if pain not relieved after first dose.

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Nitroglycerin side effects

Headache, hypotension, flushing, and tachycardia.

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Post-op Cardiac Assessment

Assess for cardiac tamponade following cardiac surgery.

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Atherosclerosis effect

Impedes blood flow to the myocardium, increasing the risk for coronary artery occlusion.

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Atherosclerosis Risk

Narrows vessel lumen leading to reduced tissue perfusion

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Modifiable CAD risk factors

Diabetes, hyperlipidemia, metabolic syndrome, obesity, physical inactivity, and tobacco use.

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Chemical Agents Impact

Substances (homocysteine) that damage the endothelial lining of arteries, increase the risk for thrombus formation and lead to stroke, coronary artery disease and peripheral vascular disease.

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Target organ damage from Hypertension

Damage to the eyes, nerves, and kidneys from prolonged high blood pressure.

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Spironolactone

Potassium-sparing diuretic; monitor for fluid and electrolyte imbalances, and hyperkalemia especially with potassium supplements.

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Metabolic Syndrome

Hypertension, hypercholesterolemia and abdominal obesity which increases the risk of heart disease.

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Beta-Blockers

Drugs ending in '-olol' which decrease heart rate and blood pressure and may mask hypoglycemia or worsen asthma.

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Blood Pressure Measurement

Instruct patients not to smoke or drink caffeine 30 minutes prior, support the arm at heart level, feet on the ground, and ensure the bladder width is at least 40% of limb circumference.

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Hypertensive Emergency

A severe elevation in blood pressure (systolic >180 and/or diastolic >120) with evidence of new or worsening target organ damage that requires immediate treatment.

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Rebound Hypertension

Sudden stop can cause dangerously high blood pressure.

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ACE Inhibitors

ACE inhibitors prevent angiotensin 1 from converting to angiotensin 2, reducing vasoconstriction and blood pressure.

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Study Notes

  • A reduction in cardiac output could cause a decrease in tissue perfusion, potentially leading to organ failure.

Hypertension

  • Retinopathy, neuropathy, and nephropathy are common target organs affected by long-standing hypertension.
  • Patients should avoid smoking or caffeine intake for 30 minutes before blood pressure measurement.
  • When measuring blood pressure:
    • The arm should be supported at heart level.
    • Feet should rest flat on the ground.
    • Bladder width of the BP cuff should encircle at least 40% of the limb circumference.
  • ACE inhibitors end in "pril," like captopril, and prevent angiotensin I from converting to angiotensin II; this lowers total peripheral vascular resistance and blood pressure.
  • ACE inhibitors and angiotensin II receptor blockers can increase the risk of hyperkalemia.
  • Abruptly stopping antihypertensive medications can cause rebound hypertension.
  • Target organ damage assessment is vital and indicates a risk from uncontrolled hypertension.
  • A blood pressure exceeding 180 systolic and/or 120 diastolic constitutes a hypertensive emergency if there is evidence of target organ damage or hypertensive urgency if there is no evidence of target organ damage, both requiring immediate treatment.

Medication Safety

  • Spironolactone is a potassium-sparing diuretic that may cause fluid and electrolyte imbalances, especially when combined with potassium supplements, increasing the risk of hyperkalemia.
  • Beta-blockers, like metoprolol, end in "-olol," decrease heart rate and blood pressure, and can mask signs of hypoglycemia or worsen asthma due to bronchoconstriction.

Metabolic Syndrome

  • Metabolic syndrome, characterized by hypertension, hypercholesterolemia, and abdominal obesity, elevates the risk of heart disease.

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