Nurb 370 Test 3: Htn And Heart Failure (Quiz)

Front 1

What blood pressure is considered to be hypertension?

Back 1

Greater than or equal to:
140 / 90

Front 2

HTN leads to an increased risk of what cardiovascular diseases?

Back 2

MI
Heart Failure
Stroke
Renal Disease

Front 3

What is the criteria for prehypertension?

Back 3

SBP of 120 -139

or

DBP of 80-89

Front 4

IS an increase in systole BP or diastole BP more important in developing HTN in people over 50?

Back 4

SBP

Front 5

What is the number one cause of death in US women and most developed areas of the world?

Back 5

Cardiovascular disease (CVD)

Front 6

30% of people with hypertension?

Back 6

Do not know they have it since it is generally an asymptomatic condition

Front 7

What is Cardiac Output (CO)?

Back 7

Total blood flow through the systemic or pulmonary circulation per minute

Front 8

Systemic Vascular Resistance (SVR)?

Back 8

The force opposing the movement of blood within the blood vessels

Front 9

The mechanisms that can regulate BP effect either?

Back 9

CO or SVR

Front 10

Primary hypertension?

Back 10

Elevated BP without an identified cause (90 - 95% of all cases)

Front 11

Secondary hypertension?

Back 11

Elevated BP with a specific cause that can often be identified and corrected

Front 12

When should a secondary cause of HTN be suspected?

Back 12

If a person below 20 or over 50 suddenly develops HTN (especially if it is severe)

Front 13

What is the hallmark of HTN (patho)?

Back 13

Persistently increased SVR

Front 14

What are the risk factors for primary HTN?

Back 14

Age
Alcohol
Cigarette Smoking
DM
Elevated serum lipids
Excess Sodium
Age (men until age 55 then women)
Family history
Obesity
Ethnicity (2x if Black)
Sedentary lifestyle
Socioeconomic status
Stress

Front 15

Secondary symptoms of HTN (usually after damage to blood vessels in various organs and increased workload of heart)?

Back 15

Fatigue
Reduced activity intolerance
Dizziness
Palpitations
Angina
Dyspnea

Front 16

The most common complications of hypertension are?

Back 16

Target organ diseases:

Hypertensive heart disease
Cerebrovascular disease
PVD
Nephrosclerosis
Retinal Damage

Front 17

"White coat" HTN?

Back 17

Elevated BP in clinical settings and normal BP when measured elsewhere

Front 18

Lifestyle modifications for persons with HTN?

Back 18

Weight reduction
DASH eating plan
Sodium restriction
Moderation of alcohol
Regular exercise
Avoidance of tobacco

Front 19

What does the DASH eating plan involve?

Back 19

Fish several times / week
Plenty of fruits and veggies
Increasing fiber
Lots of water

Front 20

What is the most frequent cause of secondary HTN in the U.S.?

Back 20

Excessive alcohol consumption that results in cirrhosis

Front 21

Drugs currently available for treating HTN have what two main actions?

Back 21

Decrease the volume of circulating blood

Reduce SVR

Front 22

What are the classes of drugs used to treat HTN?

Back 22

Diuretics
Adrenergic (SNS) inhibitors
Direct vasodilators
Angiotensin inhibitors
Calcium channel blockers

Front 23

What are the two classes of angiotensin inhibitors

Back 23

Angiotensin-converting enzyme inhibitors (ACE)

A-II receptor blockers

Front 24

What do angiotensin inhibitors do?

Back 24

Prevent vasoconstriction and sodium and water retention

Front 25

ACE inhibitors often have which side effect that causes people to swith to an ARB?

Back 25

Coughing

Front 26

Main side effects with HTN meds?

Back 26

Orthostatic hypertension
Sexual dysfunction
Tachycardia (vasodilators and angiotensin inhibitors)

Front 27

What time of day is BP the highest?

Back 27

Shortly after waking
(Take 24hr meds early in the morning)

Front 28

The failure to reach goal BP in patients who are adhering to full doses of a an appropriate 3 drug therapy regimen that includes a diuretic?

Back 28

Resistant hypertension

Front 29

How is orthostatic HTN defined?

Back 29

Decrease of 20 or more in SBP,
Decrease of 10 or more in DBP

AND/OR

Increase of 20 beats or more in pulse
(when going from supine to standing)

Front 30

A severe and abrupt elevation in BP, arbitrarily defined as a DBP greater than 140 is?

Back 30

Hypertensive crisis

Front 31

Who is most likely to experience hypertensive crisis?

Back 31

HTN patients who are not complying with meds or who are undermedicated

Front 32

A hypertensive emergency is often manifested as?

Back 32

Hypertensive encepholapathy syndrome including:

HA
Nausea
Vomiting
Seizures
Confusion
Stupor
Coma

Front 33

What is a good indicator of the seriousness of hypertensive crisis?

Back 33

Association of BP and target organ damage (not just BP alone)

Front 34

How quickly do you want to lower BP in a patient with hypertensive crisis?

Back 34

Over 24 to 48 hours in a stable patient
(some seriously bad shit can happen if BP is lowered too fast)

Front 35

What is the most effective IV drug for the treatment of hypertensive crisis?

Back 35

Sodium nitroprusside

Front 36

Abnormal clinical condition that results in physiologic changes of vasoconstriction and fluid retention

Back 36

Heart Failure

Front 37

HF is associated with what cardiovascular diseases?

Back 37

HTN
CAD
MI

Front 38

HF is the most common reason for hospital admission in?

Back 38

Adults over 65

Front 39

Primary risk factors for HF?

Back 39

CD and advancing age (primary)

(HTN, DM, obesity, smoking and serum lipids also risk factors)

Front 40

What is the most common cause of HF?

Back 40

Systolic failure, which results in the inability of the heart to pump blood

Front 41

What is the hallmark of systolic dysfunction?

Back 41

Decrease in the left ventricular ejection fraction

Front 42

The impaired ability of the the ventricles to relax and fill?

Back 42

Diastolic failure

Front 43

The diagnosis of diastolic failure is made on the basis of the presence of?

Back 43

Pulmonary congestion
Pulmonary HTN
Ventricular hypertrophy
(and a normal ejection fraction)

Front 44

Dilated cardiomyopathy can lead to?

Back 44

Mixed systolic and diastolic failure

Front 45

Compensatory mechanisms to try and maintain adequate CO associated with HF?

Back 45

Sympathetic nervous system activation
Neurohormonal responses
Ventricular dilation
Ventricular hypertrophy

Front 46

What is the most common form of HF?

Back 46

Left-sided failure

Front 47

Left-side failure results from ventricular dysfunction which is manifested as?

Back 47

Pulmonary congestion and edema

Front 48

What is the primary cause of right sided failure?

Back 48

Left-sided failure

Front 49

Right sided heart failure causes a backup of blood into the?

Back 49

Right atrium and venous circulation

Front 50

Venous congestion from right-sided heart failure results in?

Back 50

Jugular venous distention
Hepatomegaly
Splenomegaly
Vascular congestion of GI tract
Peripheral edema

Front 51

Acute decompensated heart failure (ADHF) typically manifests as?

Back 51

Pulmonary edema

Front 52

Clinical manifestations of pulmonary edema?

Back 52

Anxious
Pale
Possibly cyanotic
Cold and clammy skin
Severe dyspnea
Respiratory rate greater than 30
Rapid HR
Crackles
Wheezing and coughing with frothy, blood-tinged sputum

Front 53

Clinical manifestations of Chronic heart failure?

Back 53

Fatigue
Dyspnea
Tachycardia
Edema
Nocturia
Skin changes
Behavioral changes
Chest pain
Weight changes (gain at first and eventually anorexia and nausea)

Front 54

What are some complications of heart failure?

Back 54

Pleural effusion
Dysrhythmias
Left ventricular thrombus
Hepatomegaly
Renal Failure

Front 55

What are the JHACO core measures for heart failure? (4)

Back 55

1) Written discharge instructions covering all aspects of care
2) Documentation of left ventricular function
3)ACE inhibitors (angiotensin receptor blockers if ACE not tolerated) should be prescribed for patients with moderate to severe systolic dysfunction
4) Don't smoke

Front 56

How do you decrease intravascular volume?

Back 56

Diuretics

Front 57

Is the use of IV loop diuretics alone effective?

Back 57

No, associated with an increased risk of fatal dysrhythmias, aggravated renal dysfunction, and enhanced activation of RAAS and SNS.

Front 58

What medication dilates coronary arteries?

Back 58

IV nitroglycerin

Front 59

How can you reduce venous return (preload)

Back 59

Place the patient in high fowler's position

IV nitroglycerin

Front 60

What is afterload?

Back 60

Amount of work that the left ventricle has to produce to eject blood into the systemic circulation

Front 61

How do you decrease afterload?

Back 61

IV sodium nitroprusside (drug of choice for ADHF)
Morphine sulfate
Nesitride

Front 62

What pulmonary artery wedge pressure (PAWP) will generally increase CO?

Back 62

14-18 mm Hg

Front 63

Other important goals in treating patient with HF?

Back 63

Improving gas exchange and oxygenation
Reducing anxiety
Nutritional therapy
Education

Front 64

Classes of drugs used to treat HF?

Back 64

Diuretics
Vasodilators
ACE inhibitors
Angiotensin II receptor blockers
B-adrenergic blockers
Positive inotropes
BiDil

Front 65

What inotrope is a mainstay in the treatment of HF?

Back 65

Digitalis

Front 66

If someone is experiencing yellow vision, what would you expect?

Back 66

Digitalis toxicity

(other symptoms: nausea, anorexia, and vomiting)

Front 67

What effects do potassium levels have on digitalis?

Back 67

Hypokalemia enhances the action of digitalis (toxicity)

Hyperkalemia inhibits the action of digitalis

Front 68

What is the antidote to digitalis toxicity?

Back 68

Digibind

Front 69

What drug is only used in the treatment of HF in African Americans?

Back 69

BiDil

Front 70

Patients with HF should obtain vaccinations against?

Back 70

Flu and pneumonia

Front 71

What should be assessed prior to giving a B blocker or digitalis

Back 71

HR for 1 minute, may not give if lower than 50 (MD orders)