HTN
What are non modifiable risk factors of HTN (Select all that apply)
A. Alcohol use
B. Socioeconomic status
C. Family Hx
D. Type 2 diabetes
E. Gender
What is: B, C, E
Rationale; Of the listed options, we know that alcohol use and type 2 diabetes can be changed (modified). The other options cannot be changed so they would be labeled as NON-modifiable
What is the gold standard diagnostic test for HF?
What is: Echocardiogram
Rationale: This is a noninvasive test that shows live picture of your heart and shows function of the heart.
True or False: CAD is the most common type of cardiovascular disease
What is: True
True or False; a STEMI is caused by a non occlusive thrombus
What is: False
Rationale: STEMIs are occlusive (abrupt stop of blood flow through coronary arteries). NSTEMIs are non or partially occlusive
What is a Dysrhythmia?
What is: An abnormal cardiac rhythm
45 y.o Female presents to the ED complaining of a HA and increased fatigue. Patient has a history of type sleep apnea that they are currently using CPAP for, and has had her tonsils removed. BP reads 145/101. What type of HTN does this scenario describe?
What is: Secondary HTN
Rationale: Secondary HTN is high BP with a specific cause, typically an underlying health condition. In this example the patient has sleep apnea.
Name 3 precipitating causes of HF
What is: Anemia, infection and pulmonary embolism
Others: Hypothyroidism, dysrhythmias, endocarditis
Which statement by the patient would indicate the need for further teaching?
A. "I should not take my schedule furosemide at night."
B. "I should stop smoking to improve my CAD symptoms."
C. "I should be exercising at least 30 minutes a day at least 5 days a week"
D. "I can take my nitroglycerin as many times as needed to resolve my angina."
What is: D
Rationale: Nitroglycerin can be taken sublingually up to 3 times in 15 minutes, if angina isn't resolved patient should present to the ED.
Patient presents to the ED at 0900 with severe chest pain unrelieved by rest that has been occurring the last hour. What diagnostic test do you anticipate being ordered to determine if this is ACS?
What is: ECG, stress test, serum cardiac markers, electrocardiogram
True of False: You can shock a patient with pulseless electrical activity
What is: False
Rationale: a patient with this dysrhythmia would be dead, this is a rhythm that cannot be shocked because the electrical conduction of the heart is intact. The tx for this would be CPR, intubation and EPI
You are in sim and are asked to describe proper BP measurement technique. What is your response?
What is: Select properly fitted BP cuff, have patient seated quietly with their feet flat and arm at the level of the heart. Record BP.
What is the difference between systolic and diastolic HF?
What is: Systolic = decreased EF, inability to pump blood forward.
Diastolic = impaired ability of the ventricles to relax and fill
Patient presents to the ED with crushing chest pain with radiation to the right shoulder. What is your priority assessment as the RN?
A. Tell patient that everything is going to be okay
B. Obtain 12 lead EKG
C. Complete a head to toe assessment
D. Position client into a prone position and apply oxygen
What is: B
Rationale: Assessment needs to occur prior to action items. A is incorrect because it's not a priority and we dont want to give false hope. C is not a priority. D is incorrect because if we were repositioning to apply oxygen they would be in a high fowlers position (upright).
Describe ACS, what is going on ?
What is: Its an ischemic issue causing chest pain as a result of plaque accumulation of rupture that causes formation of a thrombi (blood clot)
When reviewing a patients EKG you see saw tooth waves, patient is also complaining of dizziness, what is the biggest risk you are worried about?
What is: Thrombi formation
Rationale: This scenario is describing an atrial flutter. The biggest risk is the formation of thrombi which can leave to stroke or PE
You are discharging a patient with HTN, what are your priority education points?
What is: How to properly take BP at home, medication compliance, physical activity, DASH diet, reduced sodium in diet, smoking cessation
Patient presents to the ED with hepatomegaly, JVD, enlarged spleen, edema and increased firmness and distention. What is being described?
What is: Right sided HF
What are the complications of CAD?
What is: ACS (Unstable angina, NSTEMI, STEMI)
Name the 3 main complications of ACS.
What is: Dysrhythmias, HF and cardiogenic shock
List 3 causes of PVCs
What is: Caffeine, potassium imbalance, fever
Others: Magnesium imbalance, hypoxia, MI, CAD, HF. --> This is not always something bad, could be a benign issue!
23 y.o male presents to the ED accompanied by his mother who tells you the patients been complaining of a sever HA and increased N/V. She brought the patient in because he was becoming increasingly confused and had a productive cough the last 2 days. What do you expect the patient to be diagnosed with?
What is: Hypertensive encephalopathy
Rationale: See S/S on HTN powerpoint slide 16
You are doing an assessment on a patient on the cardiac unit and your assessment is as follows:
-HR: 130 with S3/S4 sounds upon auscultation
-RR: 30, with crackles bilaterally and a non productive cough
-Patient also complains of being up at all hours of the night going to the bathroom
Question: What is the likely diagnosis in the above scenario
What is: Left sided HF
You are a new grad receiving orientation training. You are asked o describe the ABCDEF model for discharge teaching go a patient with CAD. Describe the meaning of each letter in this mnemonic.
What is -
A: Anti-platelet/anticoagulant/ACEs/ARBs/Antianginals
B: Beta blockers (BP control)
C: Cessation (smoking), CCBs, cholesterol management
D: Diet, diabetes management
E: Education, exercise
F: Flu Vaccine
What are symptoms that will be different in women with ACS?
What is: Treatment of the underlying cause
if a patient has a pulse = cardioversion, antidysrhythmics
If they don't = CPR, rapid defibrillation