Hypertension
What is the blood pressure threshold for diagnosing hypertension according to ACC/AHA guidelines?
Answer: ≥130/80 mmHg
What is the most common symptom of Peripheral Arterial Disease (PAD)?
Intermittent claudication (pain in the legs with activity, relieved by rest).
What is the primary difference between systolic heart failure (HFrEF) and diastolic heart failure (HFpEF)?
HFrEF (systolic HF) occurs when the heart can't contract effectively, leading to a reduced ejection fraction (EF <40%). HFpEF (diastolic HF) occurs when the heart can't relax and fill properly, but ejection fraction remains ≥40%.
What is the normal range for the SA node's intrinsic firing rate?
60-100 beats per minute
Which class of medications is commonly prescribed to improve circulation in patients with Peripheral Arterial Disease (PAD)?
A. Beta-blockers
B. Antiplatelets
C. Loop diuretics
D. Calcium channel blockers
B. Antiplatelets
(Aspirin and clopidogrel help prevent platelet aggregation and reduce the risk of clots in PAD.)
Which medication classes are first-line treatments for hypertension? (Select all that apply)
A. Beta-blockers
B. ACE inhibitors
C. Diuretics
D. Calcium channel blockers
E. Nitrates
Answer: B, C, D
(ACE inhibitors, diuretics, and calcium channel blockers are first-line treatments; beta-blockers are used in certain cases, and nitrates are for angina, not hypertension.)
What are two key differences in skin appearance between PAD and PVD?
A patient with right-sided heart failure is likely to exhibit which symptoms? (Select all that apply)
A. Peripheral edema
B. Pulmonary congestion
C. Jugular vein distention
D. Crackles in the lungs
E. Hepatomegaly (enlarged liver)
A, C, E
(Right-sided HF causes systemic congestion, leading to edema, JVD, and hepatomegaly.)
A patient with sinus tachycardia presents with dizziness, shortness of breath, and palpitations. What is the most likely cause?
A. Hypothyroidism
B. Fever or dehydration
C. Beta-blocker overdose
D. Hypothermia
B. Fever or dehydration
(Sinus tachycardia can be caused by fever, hypovolemia, stress, or stimulants.)
A patient with chronic venous insufficiency is prescribed warfarin for deep vein thrombosis (DVT) prevention. Which lab value should the nurse monitor to assess therapeutic effectiveness?
A. Activated partial thromboplastin time (aPTT)
B. Platelet count
C. International Normalized Ratio (INR)
D. D-dimer
C. INR
(Warfarin requires monitoring of INR, with a therapeutic range of 2.0–3.0 for DVT prevention.)
How does the Renin-Angiotensin-Aldosterone System (RAAS) contribute to hypertension?
RAAS activation leads to vasoconstriction (via Angiotensin II) and increased sodium & water retention (via Aldosterone), raising blood pressure.
A nurse is assessing a client with suspected PAD. Which findings support this diagnosis? (Select all that apply)
A. Diminished or absent pedal pulses
B. Warm, red skin on the lower legs
C. Ulcers on the toes with a punched-out appearance
D. Pain relieved with leg elevation
E. Capillary refill greater than 3 seconds
Answer: A, C, E
(Absent pulses, toe ulcers, and delayed cap refill indicate PAD; PVD has warm skin and pain relief with elevation.)
How does the Renin-Angiotensin-Aldosterone System (RAAS) contribute to worsening heart failure?
RAAS activation causes vasoconstriction (angiotensin II) and sodium/water retention (aldosterone), increasing afterload and fluid overload, worsening heart failure.
How does sinus bradycardia appear on an EKG? (Select all that apply)
A. Regular rhythm with a rate <60 bpm
B. P waves present before every QRS complex
C. Wide QRS complex
D. Irregular R-R intervals
A & B
(Sinus bradycardia is regular with a rate under 60 bpm, and P waves are present before every QRS.)
A patient with heart failure with reduced ejection fraction (HFrEF) is prescribed lisinopril (ACE inhibitor), metoprolol (beta-blocker), and furosemide (loop diuretic). What is the most critical electrolyte imbalance to monitor?
A. Hypokalemia
B. Hypernatremia
C. Hypercalcemia
D. Hypoglycemia
A. Hypokalemia
(Furosemide can cause potassium loss, leading to hypokalemia, which increases the risk for arrhythmias.)
A patient with hypertension reports headaches and blurred vision. Blood pressure is 190/110 mmHg. What complication should the nurse suspect?
A. Stroke (CVA)
B. Malignant hypertension/hypertensive crisis
C. Pulmonary edema
D. Orthostatic hypotension
B. Malignant hypertension/hypertensive crisis
(Severe hypertension with organ damage risks requires immediate intervention.)
A patient with PAD reports worsening pain in the affected limb even at rest. The nurse notes cool, pale skin and absent pulses. What is the priority intervention?
A. Apply a warm compress
B. Elevate the affected leg
C. Notify the healthcare provider immediately
D. Perform a Doppler ultrasound
Answer: C. Notify the healthcare provider immediately
(This suggests acute arterial occlusion, a medical emergency requiring immediate intervention.)
A patient with acute decompensated heart failure presents with severe dyspnea, pink frothy sputum, and crackles in the lungs. What is the priority intervention?
A. Administer IV diuretics
B. Position the patient in high Fowler’s
C. Administer digoxin for contractility
D. Prepare for emergency intubation
B. Position the patient in high Fowler’s
(High Fowler’s reduces pulmonary congestion and improves breathing, followed by diuretics and oxygen therapy.)
A patient with symptomatic sinus bradycardia presents with syncope and hypotension (BP 88/60). What is the priority intervention?
A. Administer Atropine 0.5 mg IV
B. Prepare for defibrillation
C. Perform carotid massage
D. Administer metoprolol
A. Administer Atropine 0.5 mg IV
(Atropine is the first-line drug for symptomatic bradycardia; pacing is considered if Atropine is ineffective.)
A patient with stage 2 hypertension (BP ≥140/90 mmHg) is started on hydrochlorothiazide (thiazide diuretic). What patient teaching is essential? (Select all that apply.)
A. “Take this medication at bedtime to avoid dizziness.”
B. “Increase potassium-rich foods in your diet.”
C. “Expect a slight increase in urine output.”
D. “You may stop the medication once your BP returns to normal.”
E. “Monitor for signs of dehydration, such as dry mouth and dizziness.”
Answer: B, C, E
(Hydrochlorothiazide causes increased urination, potential hypokalemia, and dehydration; it should be taken in the morning, and treatment is usually lifelong.)
A patient with a history of hypertension and chronic kidney disease (CKD) is prescribed lisinopril. What is the most important lab value to monitor?
A. Serum potassium
B. Blood glucose
C. Hemoglobin levels
D. Liver enzymes
A. Serum potassium
(ACE inhibitors like lisinopril can cause hyperkalemia, especially in patients with CKD.)
A patient with PVD presents with a swollen, painful leg. The nurse suspects a deep vein thrombosis (DVT). What is the first action?
A. Massage the leg to relieve swelling
B. Encourage ambulation to improve circulation
C. Keep the leg elevated and avoid compression therapy
D. Apply an ice pack to reduce pain
Answer: C. Keep the leg elevated and avoid compression therapy
(DVT increases the risk of pulmonary embolism; massage and ambulation are contraindicated.)
A patient with systolic heart failure (HFrEF) is prescribed metoprolol, lisinopril, furosemide, and spironolactone. What lab value requires immediate intervention?
A. Sodium = 136 mEq/L
B. Potassium = 6.2 mEq/L
C. Creatinine = 1.2 mg/dL
D. BNP = 500 pg/mL
B. Potassium = 6.2 mEq/L
(Spironolactone and lisinopril can cause hyperkalemia, requiring immediate intervention.)
A patient with new-onset atrial fibrillation (AFib) reports dizziness and palpitations. Their BP is 140/88, HR is 130 bpm, and they have a history of hypertension. What is the priority intervention?
A. Immediate electrical cardioversion
B. Administer diltiazem or beta-blocker for rate control
C. Start IV heparin before any further treatment
D. Check INR and start warfarin immediately
B. Administer diltiazem or beta-blocker for rate control
(For hemodynamically stable AFib, rate control is the first priority before considering anticoagulation or cardioversion.)
A patient with symptomatic sinus bradycardia (HR 40 bpm, dizziness, hypotension) is prescribed atropine IV push. What is the mechanism of action of this medication?
A. Blocks beta-adrenergic receptors to slow heart rate
B. Stimulates the vagus nerve to slow conduction
C. Increases sympathetic activity by blocking parasympathetic stimulation
D. Reduces myocardial contractility to lower oxygen demand
C. Increases sympathetic activity by blocking parasympathetic stimulation
(Atropine blocks the vagus nerve, increasing heart rate by reducing parasympathetic influence on the SA node.)