fnp exam 3

Question 1

which side of the heart has higher pressure and more muscle to pump to the body?

Answer 1

left side of heart

Question 2

what do the coronary vessels do?

Answer 2

provide oxygenation to the heart muscle

Question 3

arteries carry blood ____ from the heart and are filled with _____ blood (what is the one exception?)

Answer 3

away, oxygen
pulmunary artery carries DEOXYGENATED blood to the lungs

Question 4

veins carry blood _____ the heart and carry ______ blood (what is the one exception?)

Answer 4

to, deoxygenated
pulmonary vein carries oxygen rich blood from the lungs to the heart

Question 5

what and where is the SA node?

Answer 5

Natural pacemaker of the heart located in the right atrium

Question 6

What does the AV node do?

Answer 6

delays conduction to allow ventricles to fill with blood on systole

Question 7

What do the bundle of HIS/Purkinjie fibers do?

Answer 7

carry signal through the ventricles

Question 8

Starlings Law (in a healthy person)

Answer 8

the more volume in the ventricles before contraction, the higher the stroke volume. this is because the ventricles will be stretched and “bounce back” more forcefully

Question 9

classic ischemic or MI-related chest pain symptoms

Answer 9

pressure, tightness, or squeezing

Question 10

what EKG changes should trigger immediate ER referral?

Answer 10

ST-segment changes, new-onset left bundle branch block, presence of Q waves, ST elevations

Question 11

what symptoms should be sent to the ER?

Answer 11

nausea, dizziness, sweating, shortness of breath, pain radiating to the jaw or arm, crushing chest pressure

Question 12

MICE criteria for possible HF

Answer 12

Male
Infarction history (MI)
Crepitations
Edema in ankles

Question 13

Acute MI labs and normal values

Answer 13

CK-MB normal 0.24 IU/L
Myoglobin normal 50-85 ng/mL
Troponin 0-0.5 ng/mL

Question 14

Stable angina definition

Answer 14

predictable and consistent pain on exertion lasting around 5-10 minutes

Question 15

unstable angina definition

Answer 15

less frequent, lasts longer than 20 minutes

Question 16

Variant/Prinzmetal Angina

Answer 16

Pain occurs at rest with reversible ST changes

Question 17

First line meds for Stable Angina

Answer 17

(Beta Blocker or Calcium Channel Blocker) + nitrates

Question 18

Labs to get for HLD

Answer 18

Lipid panel, CBC, CMP with liver labs, TSH, CRP/ESR

Question 19

Tests to order for HLD

Answer 19

EKG, Treadmill stress test, Nuclear stress test, Echo, US, CT (calcium CT), Coronary angioplasty (refer to cards)

Question 20

First line of therapy for HLD

Answer 20

Dietary modifications (Dash diet, mediterranean diet, AHA diet)

Question 21

Gold standard for HLD meds

Answer 21

statins

Question 22

Left sided heart failure is usually due to what? and causes what symptoms? and is also called what kind of HF?

Answer 22

-due to uncontrolled HTN which causes left ventricular hypertrophy
-causes back up into the lungs (pulm s/s)
-also called SYSTOLIC HF

Question 23

who are statins for?

Answer 23

someone with
-CVD,
-CVD risk > 7.5%
-LDL > or equal to 190
-DM & LDL > or equal to 70

Question 24

what is LDL goal in DM or CV risk?

Answer 24

<70

Question 25

Normal Lipid Panel

Answer 25

Total Cholesterol: <200 LDL <100 (<70 in DM or CV risk) HDL >40 TG <150

Question 26

What level of triglycerides is LDL unreliable?

Answer 26

>500

Question 27

How frequently to monitor liver function after starting a statin

Answer 27

before, then 4-6 weeks after starting, then every 6-12 months

Question 28

Can you use a statin in pregnancy?

Answer 28

NO! Category X

Question 29

What is the EF of Reduced function HF and Preserved function HF?

Answer 29

RF <40% PF >50%

Question 30

Left side HF causes and s/s

Answer 30

causes: left ventricular hypertrophy from uncontrolled HTN causing weaker systole s/s: backs up in lungs! (dyspnea, hemoptysis, fatigue, cough, orthopnea, paroxysmal nocturnal dyspnea, crackles S3 (kentucky)

Question 31

Right side HF causes and s/s:

Answer 31

causes: usually from compensation from Left HF, usually a problem with diastole s/s: backs up in extremities, edema, nausea, right upper abdominal pain or fullness, JVD, hepatomegaly, S4 sound (tennessee)

Question 32

Labs for HF

Answer 32

CMP, BNP, Trop, Lipids, CMP, A1C

Question 33

DM meds that helps HF

Answer 33

SGLT2 inhibitor

Question 34

Meds needed for HF

Answer 34

diuretics, ACEi with BB (not for HR <60), statin

Question 35

What weights do pt need to monitor and call Dr. about?

Answer 35

If >2lbs in one day or >5lbs in one week

Question 36

when to admit patients?

Answer 36

hypoxia, gross fluid overload, pulmonary edema

Question 37

symptoms of reduced blood flow that could be from a murmur:

Answer 37

reduced blood flow, Chest pain, dyspnea, palpitations, SOB, exercise intolerance, light headedness

Question 38

Mnemonic for areas of the heart

Answer 38

All People Enjoy Time Magazine (aortic, pulmonic, Erbs point, tricuspid, mitral)

Question 39

Mnemonic for Systolic murmurs

Answer 39

MR. Peyton Manning AS MVP -mitral regurgutation -physiologic murmur -aortic stenosis -mitral valve prolapse (click)

Question 40

Mnemonic for diastolic murmurs

Answer 40

ARMS -aortic regurgitation -mitral stenosis

Question 41

Aortic Stenosis

Answer 41

systolic murmur common in elderly, heard in the 2nd/3rd intercostal space

Question 42

Smart/Mart inhalers

Answer 42

-ICS (inhaled corticosteroid) with formoterol (long acting beta agonist) -used as maintenance treatment plus whenever needed for symptom relief

Question 43

AIR inhalers

Answer 43

-anti inflammatory reliever that contains an ICS (inhaled corticosteroids) and SABA (short acting beta agonists) -Takes whenever needed for symptom relief

Question 44

bacterial bronchitis treatment

Answer 44

Macrolide (mycins) or amoxi-clav (augmentin)

Question 45

bacterial infection with emphysema treatment

Answer 45

doxy, bactrim, clarithromycin, cefaclor

Question 46

Gold grades and severity

Answer 46

1: Mild FEV1 > 80% 2: Moderate FEV1 50-80% 3: Severe FEV1 30-50% 4: Very Severe FEV1 <30%

Question 47

If eosinophil level is >300, what do you add to COPD therapy?

Answer 47

add ICS to current LABA + LAMA therapy

Question 48

Pertussis abx

Answer 48

Macrolides or bactrim if >2 months old and unable to take macrolides

Question 49

red flag labs for pertussis

Answer 49

Leukocytosis > 30,000

Question 50

how many weeks to repeat CXR after pneumonia dx to document clearance?

Answer 50

6 weeks

Question 51

What test is not recommended for dx CAP?

Answer 51

sputum culture

Question 52

CURB-65 tool

Answer 52

C-confusion U- BUN >19.6 R- respirations >30 breaths/min B- blood pressure <90/60 65- or older

Question 53

Cancer screening in older adults criteria and test

Answer 53

test: low-dose CT criteria: ages 55-80 years who smoke 30 pack years or have quit in the past 15 years

Question 54

what cardiac med can asthmatics not take?

Answer 54

Beta Blockers

Question 55

what labs is it important to monitor when taking statins

Answer 55

Liver function

Question 56

Statins that are available as low intensity

Answer 56

-statin Lova Simva Prava

Question 57

Statins that are available as high intensity

Answer 57

-statin Atorva Rosuva