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63 Cards in this Set

  • Front
  • Back
The most common heart disease for adults in the US is

a. Angina pectois

b. Coronary Artery disease

c. Myocardial infraction

d. Valvular heart disease.
b
Lumen narrowing with atherosclerosis is caused by?

a. atheroma formation on the intima

b. scarred endothelium

c. Thrombous formation

d. All of the above.
d
A healthy level of serum cholesterol would be a reading of:

a. 160 to 190 mg/dL

b. 210 to 240 mg/dL

c. 250 to 275 mg/dL

d. 280 to 300mg/dL
a
Which of the following findings is not a significant risk factor for heart disease?

a. Cholesterol 280mg/dL

b. LDL 160mg/dL

c. HDL 80mg/dL

d. A ratio of LDL to HDL of 4.5 to 1.0
c
Hypertension is repeated blood pressure measurements exceeding?

a. 110/80

b. 120/80

c. 130/90

d. 140/90
d
The incidence of caronary artery disease tends to be equal for men of women after the age of?

a. 45 yrs

b. 50 yrs

c. 55 yrs

d. 65 yrs
c
The pain of angina pectoris is produced primarily by?

a. coronary vasoconstriction

b. movement of thromboemboli

c. myocardial ischemia

d. the presence of atheromas
a
The nurse advises a patient that sublingual nitroglycerin should alleviate angina pain within?

a. 3 to 4 mins

b. 10 to 15 mins

c. 30 mins

d. 60 mins
a
Patient education includes telling someone who takes nitroglycerin sublingually that he or she should take 1 then go quickly to the nearest ER if no relief has been obtained after taking __________ tablets at 5 min intervals.
3
An antidote for propranolol hydrochloride (a beta andreergic blocker) that is used to treat bradycardia is?

a. Digoxin

b. atropine

c. protamine sulfate

d. sodium nitroprusside
b
Calcium channel blockers act by?

a. decreasing SA node automaticity

b. increasing AV node conduction

c. increasing the heart rate

d. creating a positive inotropic effect.
a
In the US about 1 million people will have an acute myocardial infarction each year. Of these 1 million what percentage will die?
25%
The classic ECG changes that occur with an MI include all of the following except?

a. an absent P wave

b. an abnormal Q wave

c. T wave inversion

d. ST segment elevation.
a
The most common site of myocardial infraction is the?

a. Left atrium

b. Left ventricle

c. right atrium

d. Right ventricle
b
Which of the following statements about myocardial infarction pain is incorrect?

a. It is relieved by rest and inactivity

b. It is substernal in location

c. It is sudden in onset and prolonged in duration.

d. It is viselike and radiates to the shoulders and arms
a
Myocardial cell damanage can be reflected by high levels of cardiac enzymes. The cardiac specific isoenzyme is?

a. alkaline phosphatase

b. creatine kinase

c. myoglobin

d. troponin
b
The most common vasodilator to treat chest pain associated with myocardial infraction is?

a. meperidine hydrochloride

b. hydromorphone hydrochloride

c. morphine sulfate

d. codeine sulfate.
c
The need for surgical intervention in coronary artery disease (CAD) is determined by the:

a. amount of stenosis in the coronary arteries.

b. myocardial area served by teh stenotic artery.

c. occurrence of previous infraction related to the affected artery.

d. all of the above.
d
A candidate for percutaneous transluminal coronary angioplasty (PTCA) is a patient with coronary artery disease who?

a. has compromised left ventricular function

b. has had angina longer than 3yrs.

c. Has at least 70% occlusion of a major coronary artery

d. has questionable left ventricular function.
c
A goal of dilation in PTCA is to increase blood flow through the artery's lumen and achieve a residual stenosis of less than?

a. 20%

b. 35%

c. 60%

d. 80%
a
The nurse expects a postoperative PTCA patient to be discharged?

a. the same day as surgery

b. within 24hrs

c. 3 days later

d. after 1 week
b
The nurse needs to be alert to asses for clincial symptoms of possible postoperative complications of PTCA which include?

a. abrupt closure of the artery

b. Greater than 60% blockage in the left main coronary artery

c. unstable angina

d. all of the above.
d
A candidate for coronary artery bypass grafting (CABG) must meet which of the following criteria?

a. A blockage that cannot be treated by PTCA

b. Greater than 60% blockage in teh left main coronary artery

c. Unstable angina

d. All of the above
d
The most common nursing diagnosis for patients awaiting cardiac surgery is?

a. activity intolerance

b. fear related to the surgical procedure.

c. decreased cardiac output

d. anginal pain
b
Extremity paresthesia dysrhythmias (peaked T waves) and mental confusion after cardiac surgery are signs of electrolyte imbalance related to the level of?

a. calcium

b. magnesium

c. potassium

d. sodium
c
A complication after cardiac surgery that is associated with an alteration in preload is?

a. cardiac tamponade

b. elevated central venous pressure

c. hypertension

d. hypothermia
a
The leading cause of death in the US for men and women off all ethnic and racial groups is?
Cardiovascular disease
The most common cause of cardiovascular disease is?
Atherosclerosis
The most frequently occurring sign of myocardial ischemia is?
Chest pain referred to as angina pectoris
More than 50% of people with coronary artery disease have the risk factor of?
age; more than 50% are older than 65 yrs of age
List seven modifiable risk factors that are considered major causes of coronary artery disease.
1. hypertension
2. hyperlipidemia
3. cigarette smoking
4. obesity
5. diabetes
6. metabolic syndrome
7. physical activity
A positive diagnosis of metabolic syndrome occurs when three of the following six conditions are met.
Insulin resistance
central obesity
dyslipidemia
hypertension
increased levels of C reactive protein (proinflammation)
elevated fibrinogen levels (prothrombic)
Management of coronary heart disease requires a therapeutic range of cholesterol and lipoproteins and acceptable blood level of total cholesterol is _________ with an LDL/HDL ratio of ____________ . The disired level of LDL should be ________ mg/dL and the HDL level should be greater than __________mg/dL. Triglycerides should be less than ___________ mg/dL
Total cholesteral of less than 200mg/dL

LDL/HDL ratio of 3.5 to 1.0

LDL should be less than 100mg/dL

HDL should be greater than 60mg/dL

Triglycerides should be less than 150mg/dL
The American Heart Association recommends that an average American diet contain about ____ % of fat.
25 to 35%
List five collaborative problem for a patient with angina.
1. acute coronary syndrome
or myocaridal infraction
2. dysrhythmias
3. cardiac arrest
4. heart failure
5. cardiogenic shock
The key to diagnostic indicator for myocardial infarction seen on an electrocardiogram is?
An elevated ST segment in tow contiguous leads
The vessel most commonly used for CABG is the?
Great saphenous vein
List seven symptoms seen in postpericardiotomy syndrome.
Fever, pericardial pain, pleural pain, dyspnea, pericardial effusion, pericardial friction rub, and arthralgia
Explain why coronary artherosclerosis is such a damaging process.
Atherosclerosis the abnormal accumulation of lipid substaqnces causes a repetitive inflammatory response that alters the structure and biochemical properties of arterial walls.
Explain how cigarette smoking contributes to the development of coronary artery disease.
Cigarette smoking contributes to coronary heart disease in three ways. Smoke inhalation increases the level of blood carbon monoxide bycausing hemoglobin to combine more readily with carbon monoxide than with oxygen. Nicotinic acid triggers the release of catecholamines which raise heart rate and blood pessure and cause the coronary arteries to constrict. Smoking causes a detrimental vascular response and increases platelet adhesion increasing the probability of thrombus formation.
_______ is predictable and consistent pain that occurs on exertion and is relieved by reast and or nitroglycerin
Stable angina
__________ (also called preinfarction angina or crescendo angina) symptoms increase in frequency and severity; may not be relieved with rest or nitroglycerin
Unstable angina
_______ severe incapacitating chest pain
Intractable or refactory angina
__________ (also called prinzmetal's angina) pain at rest with reversible ST segment elevation; thought to be caused by coronary artery vasospasm.
Variant angina
_________ objective evidence of ischemia (such as electrocardiographic changes with a stress test) but patient reports no pain.
Silent ischemia
What is angina pectoris?
It is a clinical syndrome usually characteristic by episodes or proxysms of pain or pressure in the anterior chest. The cause is insufficient coronary blood flow resulting in a decreased oxygen supply when there is increased myocardial demand for oxygen.
Describ the underlying pathophysiology that causes a normal artery to narrow because of atheroma deposits.
Arterial lemon narrowing begins with the deposit of fatty streaks (lips) on the intima (inter vessel wall) of the artery. Some develop into advance lesions as atherosclerosis advances. An inflammation response occurs and macrophages infiltrate the area ingest and transport lipids into the arterial wall. Smooth muscle cells then proliferate and form a fibrous cap around a dead fatty core. These deposits called atheromas narrow and obstruct blood flow. A ruptured plaque can from a thrombus.
An atheroma is described as"
An atheroma, also called plaque, is a fibrous cap of smooth muscle cells that form over lipid deposits within the arterial vessels protrude and narrow the lumen, and then obstruct blood flow.
A possible complication of rupture or hemorrhage of the lipid core into the plaque is?
The formation of a thrombus
A thrombus id a dangerous complication of atherosclerosis because it can lead to ____________ and ___________.
A thrombus can obstruct blood flow, cause acute myocardial infarction, or result in sudden death.
True or false?

Smoking increases CO levels and hemoglobin combines more readily with CO than with O2, thereby limiting the oxygen being supplied to the heart
True
True or false?

Smoking increases platelet adhesion which increases thrombus formation.
True
Why are calcium channel blockers helpful?
Becausee they increase myocardial oxygen supply by dilating the smooth muscle wall of the coronary arterioles, and by decreasing myocardial oxygen demands and decreasing systemic arterial pressure.
The nurse knows that the basic cause of angina pectoris is believed to be?
Insufficient coronary blood flow.
The medical record lists a probable diagnosis of chronic stable angina. The nurse knows that this persons pain is?
is relieved by rest and is predictable.
Patient has nitroglycerin at her bedside to take PRN. The nurse knows that nitroglycerin does these things?
Causes venous pooling throughout the body.

dilates the coronary arteries to increase oxygen supply.

lowers systemic blood pressure
Patient is brought into the ER by EMS with a suspected MI the nurse knows that the most critical time period for his diagnosis is?
The first hour symptoms begin
Because the area of infarction develops over mins to hours the nurse knows to interpret the ECG results as indicative of initial myocardial injury as?
enlarged T wave
The nurse evaluates a series of Lab tests within the first few hours. She knows that a positive indicator of cell damage is?
Elevated creatine kinase (CK-MB)
The nurse needs to look for symtoms assciated with one of the major causes of sudden death during the first 48hrs which is?
Cardiogenic shock
The nurse is aware that ischemic tissue remains sensitive to oxygen demands because scar formation is not seen until the _____ week.
Third week
Mr. Lillis needs to be advised that myocardial healing will not be complete for how long?
2 months
When discharging Mr. Lillis what teaching do you need to do?
Avoid large meals

exercise daily

Restrict caffeine containing beverages