Exam 3 (Cardio-1)

Question 1

PVR

Answer 1

peripheral vascular resistance
preload, afterload, contractility

Question 2

CO x PVR = ?

Answer 2

CO x PVR = BP

Question 3

BP of 139/82 , what is the plan, what is the stage

Answer 3

start with hydrochlorothiazide (diuretic) as the first line anti HTN medication
STAGE 1

Question 4

Drug therapy and lifestyle modifications combined can control BP in most patients with chronic hypertension

Answer 4

True

Question 5

which 2 medications primarily work for the hypertensive patient by decreasing HR and contractility

Answer 5

Beta Blockers (beta 1), Calcium Channel Blockers

Question 6

in the patient with hypertension and _______, decreasing contractility must be approached with great caution

Answer 6

!heart failure!
we dont want to lose more contractility

Question 7

would the nurse recommend the use of a beta blocker for a person with hyperthyroidism or hypothyroidism?

Answer 7

hyperthyroidism

Question 8

would the nurse recommend the use of a beta blocker for a person with an AV block?

Answer 8

no

Question 9

how do beta blockers mask hypoglycemia?

Answer 9

they block the classic signs, like an increased heart rate

Question 10

how do diuretics work?

Answer 10

decrease the reabsorption of sodium and chloride
(solutes stay IN the nephron, this allows water to follow and increase flow of urine)

Question 11

which type of diuretic places the patient at greatest risk for hypokalemia?

Answer 11

loop diuretic, because we are disrupting the sodium potassium pump

Question 12

by decreasing the reabsorption of sodium and chloride, it puts the patients at risk for

Answer 12

hyponatremia, hypovolemia, hypokalemia, dehydration, hyperuricemia (uric acid), hyperglycemia

Question 13

why are we causes with people with unstable glucose levels?

Answer 13

at risk for hyperglycemia
in GM patients, it inhibits the release of insulin, so glucose goes up

Question 14

a patient with HTN will start HCTZ what labwork will the nurse check prior to starting the medication

Answer 14

renal function labs

Question 15

which of these lab results would cause the nurse to hold the furosemide ?
A) glucose 109
B) Na+ 135
C) K+ of 3.1
D) Ca+ 6.9

Answer 15

the potassium, should be 3.5-5

Question 16

The patient on a beta blocker and a loop diuretic reports a change in balance and hearing. these changes are because of which medication?

Answer 16

the loop diuretic

Question 17

what are the two main results of the the RAAS?

Answer 17

increased volume in blood pressure &
vasoconstriction

Question 18

What are three indications for Aldosterone Receptor Blockers? What are three ADRs for ARBs?

Answer 18

indications: Heart Failure, MI, Stroke, Diabetic Nephropathy
ADR: dizziness, headache, fatigue, angio edema (swelling of the airway), fetal danger, renal failure, orthostatic hypotension

Question 19

what are four indications for ACE inhibitors? What are three ADRs for ACE inhibitors?

Answer 19

indications: HTN, Heart Failure, M.I., Diabetic and non-diabetic Nephropathy
ADRs: orthostatic HTN, angio edema (swelling of the airway), hyperkalemia, persistent dry cough, kidney failure, fetal danger

Question 20

what is the role of aldosterone in normal situations and with RAAS agents?

Answer 20

it reabsorbs sodium which leads to water reabsorption
(with too much aldosterone we have a decreased potassium reabsorption)

Question 21

how is renal stenosis related to ace inhibitors?

Answer 21

you wouldnt want to give an ace inhibitor to someone with renal stenosis because kidney failure is an ADR

Question 22

who is more at risk for hyperkalemia, someone on ACE or ARBs?

Answer 22

ACE

Question 23

what are signs of hyperkalemia? what can we teach our patient about avoiding hyperkalemia?

Answer 23

muscle weakness, nausea and vomiting,
*avoid salt substitutes (which contain potassium)

Question 24

when do we use nitroprusside? how does it work? how long can we keep the drip going?

Answer 24

in a hypertensive crisis, so diastolic over 110
it relaxes arteries and the veins
it decreases preload and afterload
not more than 72 hrs because of toxicity

Question 25

drugs that inhibit RAAS decrease BP by which mechanism?
A) decrease vasoconstriction by angiotensin 2
B) decrease resistance and decrease volume expansion
C) decrease contractility

Answer 25

decrease resistance and decrease volume expansion

Question 26

for which drug is impotence, menstrual irregularities, and gynecomastia and ADR?

Answer 26

the aldosterone antagonist diuretic
SPIRONOLACTONE

Question 27

MOA of
1) Enalapril
2) Losartan
3) Eplerenone

Answer 27

Enalapril: blocks conversion of angiotensin 1 to 2
Losartan: blocks the action of angiotensin 2
Eplerenone: aldosterone receptor blockade

Question 28

MOA of
1) Nitroprusside
2) Clonidine
3) Metoprolol
4) Doxazosin

Answer 28

1) Nitroprusside - relaxes smooth muscle of arterioles and veins
2) Clonidine - decrease outflow of the sympathetic nervous system
3) Metoprolol - decrease peripheral resistance and HR
4) Doxazosin - decrease stimulation of alpha 1 receptors

Question 29

what of the following medications might cause flushing dizziness and headache?
vasodilators, beta blockers, ace inhibitors, or diuretics

for those what are the two common ADRs?

Answer 29

vasodilators

adr: reflex tachycardia and orthostatic hypotension

Question 30

a pt has severe fluid overload, causing acute SOB, swollen ankles, fatigue
What medication would you recommend?

Answer 30

a loop diuretic such as Furosemide

Question 31

troponin is associated with ____
BNP is associated with _____

Answer 31

troponin = Cardiac damage and an MI
BNP = Heart Failure

Question 32

T/F
Diuretics are contraindicated in the treatment of a client with heart failure

Answer 32

false

Question 33

T/F
A client with heart failure might be prescribed an ACE inhibitor

Answer 33

true

Question 34

what are signs of hypokalemia

Answer 34

muscle weakness, lowered T waves
alkalosis
drowsiness, confusion
fatigue
nausea vomiting
thready pulse

Question 35

if the nurse administers nifedipine to the patient with cerebral vasospasm. which part of the CV system will be affected?
A) arterioles
B) arterioles and the heart

Answer 35

just the arterioles
because nifedipine is a selective calcium channel blocker
Nifedipine and Amlodipine (they are N/A to the heart)

Question 36

what are the non selective calcium channel blockers?

Answer 36

Verapamil and Diltiazem (which have a Very Definite effect on the heart)
they effect both he hear and arterioles/vessels

Question 37

An elderly patient is taking daily doses of the calcium channel blocker Verapamil for atrial fib, what are two things the nurse will teach the patient?

Answer 37

at risk for constipation
drink adequate amount of water each day and eat plenty of fiber in your heart
ALSO
avoid products containing grapefruit, because the grapefruit juice inhibits the metabolism of calcium, increasing the calcium level in the body

Question 38

overuse of CCBs can result in which condition?

Answer 38

serious cardio-suppresion with bradycardia and AV block

Question 39

drugs that are preferred in HTN and pregnancy?

Answer 39

methyldopa

Question 40

which of the drugs can be effective to treat supraVentricular dysrythmias?

Answer 40

Diltiazam, and Metroprolol

Question 41

What is the priority concert for the patient starting on an alpha 1 blocker ?

Answer 41

falls & safety
-osin
hypotension

Question 42

Do calcium channel blockers act similarly to beta blockers

Answer 42

Yes
Decrease conduction, contractility, vasodilate