Use LEFT and RIGHT arrow keys to navigate between flashcards;
Use UP and DOWN arrow keys to flip the card;
H to show hint;
A reads text to speech;
7 Cards in this Set
- Front
- Back
|
Persistent atrial fibrillation is diagnosed in a patient who has valvular disease, and the cardiologist has prescribed Warfarin. The patient is scheduled for electrical cardioversion in three weeks. The patient asks the NP why the procedure is necessary. The NP should tell the patient |
This medication prevents clots but does not alter rhythm. Persistent AF last longer than 7 days and episodes failed to terminate on their own, but episodes can be terminated by electrical cardioversion after therapeutic Warfarin therapy for 3 weeks. Warfarin does not alter AF. Beta blockers, calcium channel blockers, and digoxin are sometimes given to alter the rate. Verapamil is not an alternative to cardioversion for patients with persistent AF. |
|
|
A patient undergoes a routine ECG, which reveals occasional PVCs that are present when the patient is resting and disappear with exercise. The patient has no previous history of cardiovascular disease, and the cardiovascular examination is normal. The NP should |
Tell the patient that treatment is not indicated. The most important factor in determining whether to treat PVCs is the presence of underlying heart disease, such as myocardial ischemia, previous myocardial infarction, cardiac scarring or hypertrophy, or left ventricular dysfunction. Because of the risks associated with anti-arrhythmic therapy, patients should not be treated unless clear indications are present. PVCs are not treated if the patient is asymptomatic, if the patient has a normal heart, if the PVCs are simple, and if they disappear with exercise. Amiodarone is not used to treat acute PVCs but is used for a long-term prophylaxis. |
|
|
The NP sees a new patient for a routine physical examination. When auscultating the heart, the NP notes a heart rate of 78 beats per minute with occasional extra beats followed by a pause. History reveals no past cardiovascular disease, but the patient reports occasional syncope and shortness of breath. The NP should |
Order an ECG and referred to a Cardiologist. PVCs are premature ventricular Beats with a compensatory pause. This patient has no prior history, but does have syncope and shortness of breath. The NP should order an ECG and refer the patient to a Cardiologist for further evaluation. If there were no other symptoms, the NP could order stress-testing. Medications are not indicated without further testing and without consultation with a cardiologist. |
|
|
A patient comes to the clinic with a history of syncope and weakness for 2 to 3 days. The NP notes thready, rapid pulses and 3 second capillary refill. An ECG reveals a heart rate of 198 beats per minute with a regular rhythm. The NP should |
Send the patient to an emergency department for evaluation and treatment. Paroxysmal supraventricular tachycardia is a very fast regular heart rate and rhythm. This patient is becoming decompensated and should be referred to the emergency department for evaluation and treatment. The NP should not treat this in clinic or as an outpatient until the patient is stable |
|
|
A patient who is taking trimethoprim-sulfamethoxazole for Prophylaxis of urinary tract infections tells the NP that a sibling recently died from a sudden Cardiac Arrest, determined to be from Long QT syndrome. The NP should |
Order genetic testing for this patient. When a family member's death is found to be from Long QT syndrome, the entire family must undergo testing. Treadmill testing may be normal in many cases. Trimethoprim-sulfamethoxazole can prolong the QT interval and should not be used in patients at risk, but genetic testing should be performed to determine this |
|
|
The NP refers a patient to a Cardiologist who diagnoses Long QT syndrome. The cardiologist has prescribed propranolol. The patient exercises regularly and is not obese. The patient asks the NP what else can be done to minimize risk of sudden cardiac arrest. The NP should counsel the patient to |
Drink extra fluids when exercising. Patients with Long QT syndrome should avoid situations in which they might overheat or get dehydrated. This patient should be encouraged to drink plenty of fluids while exercising and should avoid activities such as yoga and hot baths. Implanted cardioverter defibrillator are used for high-risk patients. Procainamide can cause Long QT syndrome. |
|
|
A patient who has been taking quinidine for several years reports lightheadedness, fatigue, and weakness. The NP notes a heart rate of 110 beats per minute. The serum quinidine level is 6 mcg/ ml. The NP should |
Order an ECG, CBC, liver function test, and renal function tests. The therapeutic level for quinidine is 2 to 5 mcg / ml. Some patients have therapeutic responses at up to 6 mcg / ml. |
