1. CV Review Test #2 Hypertension Diuretics Valvular Disease Inflammatory Diseases of the Heart Heart Failure

2. MC Hypertension is defined as sustained systolic and diastolic blood pressure greater than: – A. 120/90 – B. 140/90 – C. 136/80 – D. 122/70

3. MC Systolic pre-hypertensive range is between ______ and ______. – A. 113-119 – B. 131 – 139 – C. 121 – 139 – D. 131 - 141

4. MC There are 2 main types of hypertension. These are: – A. Stage 1 and 2 – B. Mild and severe – C. primary and secondary – D. malignant and benign

5. T/F Primary hypertension is also called essential hypertension.

6. Complete List 4 non-modifiable risk factors for hypertension:

7. Complete List 6 modifiable risk factors for hypertension.

8. MR Secondary hypertension is attributed to an identifiable medical diagnosis. Identify contributing diagnoses below: – A. Renal Vascular disease – B. Adrenal Cortex disease – C. Co-arctation of the Aorta – D. PIH

9. Complete List 3 other causes of secondary hypertension.

10. MR Prolonged hypertension can damage the heart. Identify the negative effect of prolonged hypertension below: – A. increases the workload of the heart – B. Damages the endothelial lining of the arteries – C. accelerates atherosclerosis – D. weakens blood vessel valves

11. Fill In Malignant Hypertension refers to a systolic blood pressure of > ______ mm/Hg and a diastolic blood pressure of ______ mm/Hg.

12. T/F High blood pressure is a disease without symptoms until vascular changes in the heart, brain, eyes, or kidneys.

13. MR Clinical manifestations of high blood pressure may include which of the following: – A. Awakening with a headache – B. Awakening with clenched teeth – C. nosebleed – D. blurred vision

14. MC Which of the following would be included in objective data collection for a client being evaluated for high blood pressure? – A. client description of headache – B. client report of headache – C. VS check by the nurse – D. Height and weight check by the nurse – E. C and D only

15. Complete List 3 diagnostic tests that would be checked for a client being evaluated for high blood pressure:

16. Complete Management of hypertension by modifying risk factors is considered the first line of therapy. The nurse can participate in patient education for which risk factors: – List 4.

17. Complete List 5 categories of medications that might be used in the management of hypertension and name an example for each category:

18. MR When applying the diagnosis of “knowledge deficit” to a client with hypertension, the nurse will assess the client’s understanding of which two issues first? – A. medication administration – B. exercise program – C. understanding of hypertension – D. understanding of management of hypertension

19. MC If the diameter of the arteries becomes narrow, the artery loses some elasticity, the blood becomes thicker, and the total blood volume increases, what is the effect on the blood pressure? – A. decreases – B. increases – C. no change – D. becomes irratic

20. MC Knowing that a nephron is the functioning unit in the kidney that filters the blood, one of the nephron’s primary jobs is to excrete and reabsorb sodium. Where sodium goes, _______ goes also. – A. circulating fluid – B. water – C. lymph – D. White blood cells

21. MC Medication that is given to release the fluid from the body is called a/an: – A. analgesic – B. aminoglycoside – C. diuretic – D. alpha or beta blocker

22. Complete Different classes of diruetics work on different parts of the nephron. List these 3 parts:

23. MC When a patient is on Digoxin and also taking a diuretic, the nurse should monitor the client for s/sx of: – A. thirst – B. enhanced cardiac response – C. digoxin toxicity – D. nephrotoxicity

24. Complete List 4 signs of Digoxin toxicity.

25. MR Which of the following are basic nursing measures to implement when monitoring a patient on a diuretic? – A. daily weights (preferably in the morning) – B. Teach client to take the diuretic in the morning – C. Teach the client s/sx of other medication toxicity to report to the doctor (digoxin, lithium, etc.) – D. Teach the client s/sx of dehydration and to contact the MD

26. Complete Aldosterone, is a _________ ________ produced by the adrenal gland, and acts on the kidney nephron to _______ sodium, _______ water retention, ________ (get rid of) potassium, and ____________ blood pressure.

27. Complete When discussing antihypertensive medications, the following terms may be used: onset of action, peak of action, and half- life. Define each of these terms.

28. Match – drug/action Drug Thiazide Diuretic Loop Diuretic Osmotic Diuretic Potassium – sparing diuretic ACE - Inhibitor Action Prevents Angiotensin 1 from converting to Angiotensin II and therefore causes vasodilation  ↓ BP ↑ Na+ and water excretion by stopping Na+ reabsorption in the distal tubule of kidneys Stops Na+ and Cl- reabsorption from loop of Henle and distal tubule in kidneys Act on the distal tubule of the kidneys to promote Na+ and H20 excretion and retention of K+

29. Complete List one common drug associated with each category of diuretic: – Thiazide Diuretic – Loop Diuretic – Osmotic Diuretic – Potassium-sparing Diuretic – ACE-Inhibitor

30. MR Nursing management of clients on diuretics include which of the following actions: – A. Daily weight (morning – B. Intake and Output record – C. VS, esp. BP – D. Watch for s/sx digoxin and lithium toxicity – E. Watch for development of a cough – F. Watch for s/sx renal failure

31. MC Clients on diruetics also need to be observed for: – A. s/sx of low potassium – B. low sodium – C. s/sx dehydration – D. All of the above

32. MC Beta blocking medications block the release of epinephrine and nor-epinephrine which will have which effect? – A. Stimulate alpha-receptors in the CNS to inhibit vasoconstriction – B. Interrupts the flow of calcium into cells of cardiac muscle and vascular smooth muscle  relaxation of smooth muscle – C. Block the release of epinephrine and norepinephrine  ↓ heart rate and BP – D. Directly dilates peripheral arterioles  ↓ BP

33. Complete List 3 nursing actions for the nursing diagnosis: risk for fluid volume deficit

34. Fill In Heart valves operate by passively opening and closing in response to _______ changes in the heart. Valvular disease occurs when the valves are compromised and don’t ________ and __________ properly.

35. MC Valvular heart disease is usually in one of 2 categories. When the valve tissue become thick, they also become narrow. This condition is referred to as: – A. Stenosis – B. Sclerosis – C. Hypertrophied – D. shrinkage

36. MC Valvular insufficiency occurs when valves are: – A. unable to close completely – B. too relaxed to function properly – C. too tight to open adequately – D. unable to flex in either direction to open or close

37. MR In Mitral Stenosis when the flow of blood from the LA to the LV is obstructed, what results will the nurse find? – A. lower extremity pitting edema – B. Crackles, rales, rhonchi in the lungs – C. Low BP and low cardiac output – D. LV hypertrophy

38. MR When a patient has a diagnosis of mitral insufficiency, the blood from the LV flows back into the LA during systole, it results in which of the following? – A. LA dilation – B. lower extremity edema – C. left-sided heart failure – D. right-sided heart failure

39. MC Which one of the following valvular conditions would cause a “click” sound when cusps of the valve prolapse into LA during systole? – A. Aortic Stenosis – B. Mitral Stenosis – C. Pulmonic Stenosis – D. Mitral Valve Prolapse

40. MC In this condition, the valvular opening is narrowed and obstructs blood flow from the LV to the aorta. Consequently, this causes pressure to increase in the LV. This condition is known as: – A. Aortic regurgitation – B. Aortic stenosis – C. Pulmonic stenosis – D. Mitral insufficiency

41. MR When LV pressure increases, the following results are observed: – A. increase workload on the heart – B. Left-sided heart failure – C. Poor coronary artery perfusion – D. RV hypertrophy

42. Fill In During pulmonic stenosis the ___ outflow is obstructed and causes ________ sided heart failure.

43. Complete Diagnostic tests for valvular disease include: List 3:

44. Complete Medical treatment of valvular disorders include treating heart failure. List 3 medical measures that may be used to treat heart failure:

45. Complete Open heart surgery is one of the treatments for valvular disorders. What kind of surgical procedures can be used to treat these disorders?

46. MR Goals of nursing interventions with valvular disorders include: – A. Symptomatic relief/ promote comfort – B. Assist with ADL’s – C. Support vigorous exercise program starting on the 1 st day post op – D. all of the above

47. Complete List nursing tasks that you would do in a nursing assessment for a patient who is one day post-op valve repair.

48. MR An infection or inflammation of the inner membranous lining of the heart, esp. valves is known as: – A. Pericarditis – B. Rhematic heart disease – C. myocarditis – D. Endocarditis

49. Other Describe the effect of inflammation in the endocarial lining of the heart. See lecture slide #7.

50. Complete List 5 diagnostic tests used to determine endocarditis:

51. MC When assessing a client for endocarditis, the nurse would document which of the following if present or if client confirms experiencing them: – A. malaise and night sweats – B. weight loss and/or anorexia – C. heart murmur – D. all of the above

52. MC Osler’s nodes are a noteworthy symptom when assessing a client with endocarditis. These are: – A. non-tender, small erythematous or hemorrhagic macules or nodules in the palms or soles – B. painful, red, raised lesions on the fingers and sometimes seen on the soles of the feet. – C. Short, thin, brown, linear streaks in the nails

53. MR In addition to PCN and Gentamycin to treat the infection of endocarditis, the nurse knows that “rest”, which includes bedrest, is a significant treatment for what reasons? – A. Reduces the workload of the heart – B. Supports treatment for elevated temperature – C. Supports treatment for heart failure – D. Reduces fluid requirement

54. MC One of the medical goals for endocarditis is to prevent complications - especially the risk for: – A. contagion – B. hemorrhage – C. emboli – D. pneumonitis

55. MC Myocarditis is an inflammation of the _________ of the heart caused by virus, bacteria, or fungi. – A. Pericardial sac – B. Pericardium – C. myocardium – D. endocardium

56. Fill In My ocarditis may lead to hypertrophy, _________ and decreased ___________ leading to dilation of the chambers and possibly damage the conduction system  ___________.

57. Other List 4 diagnostic tests related to testing for myocarditis:

58. List 6 symptoms of myocarditis:

59. MR Myocarditis is treated with which of the following: – A. Antibiotics and Anti-inflammatory meds – B. Rest – C: Treatment of further complications such as heart failure or valvular insufficiency – D. vigorous exercise program

60. Other Describe the process of pericarditis according to sl. 19 of the lecture.

61. Complete List 4 diagnostic tests/procedures used to determine pericarditis.

62. List 4 s/sx of pericarditis that the patient may complain about, or you might discover during your nursing assessment:

63. MC Constrictive pericarditis is due to a thickened, fibrotic pericardium that forms a non- compliant shell around the heart. This shell prevents the heart from: – A. expanding when blood enters it. – B. contracting – C. pumping – D. Normal electrical conduction

64. MC Constrictive pericarditis can be cured with: – A. medication – B. cardiac catheterization – C. pericardial stripping – D. coronary by-pass grafting

65. MR Cardiac tamponade occurs when: – A. there is too much fluid in the pericardial sac – B. fluid in the pericardial sac compresses the heart – C. a compressed heart impairs systole and diastole – D. conduction system is infected

66. MC The patient with cardiac tamponade is at high risk for: – A. infection – B. decreased cardiac output – C. change in electrical activity of the heart – D. A and C only

67. MR Signs and symptoms of cardiac tamponade include which of the following: – A. Pulsus paradoxus – B. Muffled heart sounds – C. JVD – D. Restlessness and anxiety – E. Narrowed pulse pressure

68. MR One of the nursing goals for a client with cardiac tamponade would be to: – A. start a vigorous exercise program – B. provide rest – C. reduce workload of the heart – D. comfort measures/pain and anxiety control

69. T/F Heart failure is the inability of the heart to fill with blood and/or pump blood, sufficiently.

70. MC Heart failure may result in which of the following? – A. intravascular fluid volume overload – B. Intrastitial fluid volume overload – C. An inability to meet the demands of the body – D. all of the above

71. Complete List the 3 key aspects of heart failure:

72. MC There are 2 types of heart failure which are referred to as: – A. Superior and inferior heart failure – B. atrial and ventricle failure – C. right and left sided heart failure – D. depolarization and repolarization failure

73. Complete List 7 causes of heart failure

74. MR During right-sided heart failure, 2 mechanisms contribute to it’s cause. Identify these mechanisms below: – A. the right ventricle is unable to fill with a sufficient amount of venous blood – B. the left ventricle is unable to fill with venous blood – C. the right ventricle is unable to effectively pump blood forward to the pulmonary circulation – D. the left ventricle is unable to effectively pump blood forward to the pulmonary circulation

75. Complete Right-sided heart failure has a number of causes that contribute to this condition. List 5 of the causes below:

76. MR COPD increases pressure in the Pulmonary arteries. Over time the increased pressure on the right ventricle causes it to dilate or hypertrophy. What would the nurse observe when a client has a dilated or hypertrophied right ventricle: – A. an inability of the right ventricle to eject all of its blood volume forward – B. blood back-up in the right atrium and then the veins – C. pulmonary edema – D. peripheral edema

77. MR In left-sided heart failure, 2 mechanisms contribute to it’s cause. Identify these mechanisms below: – A. the left ventricle is unable to fill with a sufficient amount of blood – B. the right ventricle is unable to fill with venous blood – C. the left ventricle is unable to effectively pump blood forward to the rest of the body – D. the right ventricle is unable to effectively pump blood forward to the pulmonary circulation

78. Complete List 3 causes of left-sided heart failure.

79. MR Significant signs and symptoms of left-sided heart failure include which of the following: – A. decreased cardiac output – B. pulmonary congestion – C. pulmonary edema – D. pleural effusion

80. MR When doing a nursing assessment for a patient with either left- or right-sided heart failure, the nurse would determine subjective data which would include: – A. c/o dyspnea – B. c/o orthopnea – C. c/o fatigue – D. c/o weight gain

81. Complete List 4 diagnostic tests used to confirm diagnosis of heart failure:

82. MR Medical goals of managing heart failure include: – A. increase cardiac efficiency – B. increase oxygen requirements – C. treat edema – D. treat pulmonary congestion

83. Complete List 4 medical treatments for heart failure:

84. MC __________ is a common and important medication used to treat heart failure. It’s onset of action is in 2-6 hrs; has a normal serum range of 0.5 – 2 ng/mL; and may cause side effects such as bradycardia, and hypokalemia. – A. Lithium – B. Propanolol – C. Digoxin – D. Furosemide (Lasix)

85. Complete List 3 goals of nursing intervention in patients with heart failure: – 1. – 2. – 3.