Exam 2 Medsurg Cardiac

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  • 1/13 Questions

    Differentiate hypertensive emergency from hypertensive urgency.

    • In Hypertensive emergency blood pressure is elevated but there is no evidence of target organ damage
    • Elevated BP associated with headache or nosebleed is defined as emergency. 
    • The therapeutic goal is to return BP to less than 140/90 in hypertensive emergency.  
    • The therapeutic goal in hypertensive emergency is to lower the blood pressure by 20% within the hour.  In urgency, oral drugs are used and the goal is normalization of BP within 24 to 48 hours. 
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About This Quiz

This quiz covers key concepts in cardiac nursing, focusing on mitral regurgitation, blood pressure management, orthostatic hypotension, and cholesterol levels.

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  • 2. 

    A major reason for slowing down the heart is which of the following.  

    • It can prevent the throwing of emboli.  

    •     It improves passive ventricular filling and can improve cardiac output (especially in diastolic heart failure). 

    • The major reason for slowing the heart is to decrease valvular dysfunction.

    • Slowing of the heart rate is almost never a goal of therapy.  

    Correct Answer
    A.     It improves passive ventricular filling and can improve cardiac output (especially in diastolic heart failure). 
    Explanation
    Slowing down the heart can improve passive ventricular filling and enhance cardiac output, particularly in cases of diastolic heart failure. This is because a slower heart rate allows for more time for the ventricles to fill with blood during diastole, leading to increased preload and subsequently improved cardiac output. This can be beneficial in patients with diastolic heart failure where the ventricles are stiff and have difficulty filling properly. By slowing down the heart rate, the heart is able to compensate for the impaired filling and maintain adequate cardiac output.

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  • 3. 

    Which of the following can potentiate orthostatic hypotension? 

    • Concomitant intake of diuretics with opioids or alcohol, especially in the geriatric population. 

    • Administration of more than one class of antihypertensive drugs.  

    • Fluid volume deficits.

    • All of the above can potentiate, therefore BP should routinely be taken on all these patients in at least 2 positions.  

    Correct Answer
    A. All of the above can potentiate, therefore BP should routinely be taken on all these patients in at least 2 positions.  
    Explanation
    The correct answer is that all of the above can potentiate orthostatic hypotension. This means that concomitant intake of diuretics with opioids or alcohol, administration of more than one class of antihypertensive drugs, and fluid volume deficits can all increase the risk of orthostatic hypotension. Therefore, it is important to routinely measure blood pressure in at least 2 positions in patients with these risk factors.

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  • 4. 

    Which patient would be said to be orthostatic? 

    • A patient with a difference when going from sitting to standing of     20mm Hg in systolic or 10mm Hg in diastolic BP.  

    • A patient with a 20-point differentiation in BP from one arm to the     other. 

    • A patient with a palpated and auscultated pulse differential of more     than 10 points

    • All of these patients are evincing classic signs of orthostasis

    Correct Answer
    A. A patient with a difference when going from sitting to standing of     20mm Hg in systolic or 10mm Hg in diastolic BP.  
    Explanation
    A patient would be said to be orthostatic if there is a significant difference in blood pressure when transitioning from sitting to standing. This can be indicated by a change of 20mm Hg in systolic blood pressure or 10mm Hg in diastolic blood pressure. This change in blood pressure can cause symptoms such as lightheadedness or dizziness.

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  • 5. 

    Which of the following is the most critical measurement of BP when you are concerned with organ (brain, kidney, gut, liver) perfusion?

    • Mean Arterial Pressure.

    • Pulse pressure.

    • Systolic BP.

    • Diastolic BP. 

    Correct Answer
    A. Mean Arterial Pressure.
    Explanation
    Mean Arterial Pressure (MAP) is the most critical measurement of BP when concerned with organ perfusion. Unlike systolic or diastolic BP, which only provide information about the pressure during specific phases of the cardiac cycle, MAP takes into account the average pressure throughout the entire cycle. This is important for organ perfusion because it reflects the pressure that organs are exposed to during both systole and diastole, ensuring a continuous supply of oxygen and nutrients. Pulse pressure, on the other hand, represents the difference between systolic and diastolic pressure and is not as indicative of organ perfusion as MAP.

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  • 6. 

    In an 87-year-old patient with no diabetes or kidney disease which is the recommendation for managing BP?  

    • Maintain BP below 150/90.

    • Maintain BP below 140/90

    • Maintain BP below 130/90

    • Maintain BP below 120/80

    Correct Answer
    A. Maintain BP below 120/80
    Explanation
    The recommendation for managing blood pressure in an 87-year-old patient with no diabetes or kidney disease is to maintain blood pressure below 120/80. This is because maintaining blood pressure within this range has been shown to reduce the risk of cardiovascular events and complications in older adults.

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  • 7. 

    Your patient has been diagnosed with infective endocarditis.   What do you expect for assessment findings in this patient?

    • Insidious onset, intermittent fever, murmurs that worsen over time,     petechial on the body, splinter hemorrhages under nails.

    • Rapid onset, tachycardia, chest pain, new dysrhythmias, persistent     fever. 

    • Often there are no definitive symptoms in endocarditis.

    • Signs and symptoms mimic systolic heart failure. 

    Correct Answer
    A. Insidious onset, intermittent fever, murmurs that worsen over time,     petechial on the body, splinter hemorrhages under nails.
    Explanation
    Infective endocarditis is an infection of the inner lining of the heart chambers and valves. The assessment findings mentioned in the answer are characteristic of infective endocarditis. Insidious onset refers to a gradual and subtle development of symptoms. Intermittent fever indicates that the patient may experience periods of fever followed by periods of normal temperature. Murmurs that worsen over time suggest the involvement of the heart valves. Petechial on the body and splinter hemorrhages under the nails are specific physical findings associated with infective endocarditis. These findings help in identifying and diagnosing the condition.

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  • 8. 

    A patient has mitral regurgitation (insufficiency).  When will you hear the murmur in the cardiac cycle? 

    • In systole (between S1 and S2).

    • It will depend on whether this is early or late MR. 

    • There is no murmur associated with MR.

    • In diastole between (S2 and S1)

    Correct Answer
    A. In systole (between S1 and S2).
    Explanation
    In mitral regurgitation, the mitral valve fails to close properly during systole, causing blood to flow back into the left atrium. This creates a turbulent flow of blood, which produces a murmur. The murmur is heard between the first heart sound (S1) and the second heart sound (S2) because this is when the mitral valve should be closed. Therefore, the correct answer is that the murmur is heard in systole (between S1 and S2).

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  • 9. 

    A patient has an S3, in what portion of the cardiac cycle will you hear this gallop?  

    • In early diastole (during passive filling)

    • In late diastole during atrial kick! 

    • N early systole.

    • In late systole.

    Correct Answer
    A. In early diastole (during passive filling)
    Explanation
    During the cardiac cycle, the S3 heart sound occurs in early diastole during passive filling. The S3 sound is caused by the rapid deceleration of blood flow during the rapid filling phase of the ventricles. This occurs immediately after the S2 sound, which is the closure of the semilunar valves. The S3 sound is often associated with conditions such as heart failure or volume overload, where there is increased blood volume in the ventricles during diastole. Therefore, it is heard in early diastole when the ventricles are relaxed and filling with blood.

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  • 10. 

    A patient with a total cholesterol of 196, An HDL of 68 and LDL of 85 is said to have…

    • Borderline hyperlipidemia.

    • Pre-hyperlipidemia

    • Hyperlipidemia.

    • Normal cholesterol levels

    Correct Answer
    A. Normal cholesterol levels
    Explanation
    Based on the given values, the patient's total cholesterol level is within the normal range (less than 200 mg/dL). Additionally, the HDL (good cholesterol) level is high, which is desirable, and the LDL (bad cholesterol) level is also within the normal range (less than 100 mg/dL). Therefore, the patient's cholesterol levels are considered normal.

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  • 11. 

    N a patient with pulmonary hypertension and right sided heart failure.   You are most concerned with which of the following?

    • Volume status.

    • Left ventricular hypertrophy

    • Oxygenation.

    • The risk for throwing emboli

    Correct Answer
    A. Oxygenation.
    Explanation
    In a patient with pulmonary hypertension and right-sided heart failure, the most concerning factor is oxygenation. Pulmonary hypertension causes increased pressure in the pulmonary arteries, leading to decreased blood flow and oxygenation to the lungs. Right-sided heart failure occurs as a result of the increased workload on the right side of the heart. Decreased oxygenation can further worsen the heart failure and lead to systemic hypoxia, which can have severe consequences on the patient's overall health. Therefore, monitoring and improving oxygenation is crucial in managing this patient's condition.

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  • 12. 

    Which class of drug is used to directly decrease preload? 

    • ACE inhibitors.

    • Diuretics

    • Digoxin

    • Calcium channel blockers (CCB

    Correct Answer
    A. Diuretics
    Explanation
    Diuretics are a class of drugs that are used to directly decrease preload. Preload refers to the amount of blood that fills the heart before it contracts. By increasing urine production, diuretics help to reduce the volume of blood in the body, which in turn decreases the amount of blood returning to the heart and therefore decreases preload. This helps to reduce the workload on the heart and can be beneficial in conditions such as congestive heart failure or hypertension.

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  • 13. 

    Your patient has been diagnosed with DCM (dilated cardiomyopathy).  She presents with DOE and fatigue.  What do you anticipate for early medical and nursing management?  

    • Management very similar to the management of diastolic heart     failure.  

    • Management very similar to the management in systolic heart failure. 

    • Since traditional management tends to be fruitless, surgical     management including left ventricular assist device or     transplantation is expected. 

    • Alcohol septal ablation is usually the first line treatment.

    Correct Answer
    A. Management very similar to the management in systolic heart failure. 
    Explanation
    The correct answer states that the management for DCM is very similar to the management in systolic heart failure. This means that the approach to treating DCM involves similar strategies as those used for systolic heart failure, such as medication management, lifestyle modifications, and potentially the use of devices like pacemakers or implantable cardioverter-defibrillators. This answer implies that the focus of early medical and nursing management for DCM would be on addressing the underlying causes and symptoms of systolic heart failure.

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  • Current Version
  • Aug 26, 2023
    Quiz Edited by
    ProProfs Editorial Team
  • Apr 01, 2020
    Quiz Created by
    Kaytlinedwards
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