CARDIO FINAL/PHARM REVIEWS

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1

Patient taking Cholestyramine resin(Questran) who has serum cholesterol level of 398 mg/dL. Patient statement indicate further instructions?

"I'll continue my nicotinic acid from the health food store".
nicotinic acid are contraindicated with all lipid lowering meds = liver abnormalities

2

Patient taking Gluconizol+Losartan for HTN. Risks of interaction

...

3

Patient with acute myocardial infarction receiving alteplase (tPA). What is NI priority?

Bleeding - a side effect of thrombolytics

4

Patient with history of mild heart failure receiving diltiazem(Cardizem - Calcium Channel blocker) for HTN. Nurse are to check for

Lung crackles, weight gain, peripheral edema = worsen by the medication

5

Beta Blockers

carvedilol, metoprolol

6

Antidote for Heparin

Protamine

7

Patient taking diuretic for HTN - monitor for

Potassium

8

When to withold Digoxin

Apical <60 or >100

9

Nitro lose potency if exposed to light, when to replace

smell like vinegar

10

Correct use of Nitro tab

Q 5 min . Max of 3 tabs

11

Consequence of increase BP in HTN patient with renal disease

MI

12

Ejection Fraction rate for HTN

Normal: >60% Moderate HF: 40-60% Moderate-severe HF: 20-40% Severe HF: <20%

13

Ace Inhibitors

(prils) decrease aldesterone levels, decrease BP, decrease cardial work load decrease peripheral resistance

14

Nitro transdermal patch is good for

7 days

15

Side effects of Nitro SL

headache (expected) hypotention dizziness (geriatric cautions)

16

Pre administration of cholestipol

baseline serum total and LDL-C and triglyceride levels.

17

Nitro ointment teaching

Use gloves. Measured dose on applicator.

18

Patient pre op PTCA rationale for taking aspirin

prevent thrombus formation

19

When to hold milrirone

ncreased risk of bleeding due to hypoprothrombinemia from vitamin K deficiency

20

quinidine drug interaction causing increase serum level

A fib

21

clonidine patch good for

7 days

22

procaindimide IM

in gluteus maximus

23

Patient with CHF is taking digoxin + furosemide. What data collection would lead the nurse to suspect patient is hypokalemic?

Muscle weakness+leg cramps

24

Hydrochlorothiazide (HydroDIURIL) contraindicated with

lithium,digoxin, corticosteroids, hypoglycemic medications

25

What the nurse should avoid doing in administration of nitroglycerin ointment (Nitro Bid)

Using fingers to spread the ointment. Medication is absorbed through the skin.

26

Patient with heart disease+ HTN is taking atenolol, digoxin(Lanoxin) and chlorothiazide (Diuril). Diagnosis of digoxin toxicity is made. What is supports for this diagnosis

Double vision, nausea, loss of apetite- as well as bradycardia, visual alterations(green/yellow), seeing spots or halo, confusion, vomiting, diarrhea, decreased libido, impotence

27

Teaching for postoperative patient taking warfarin (Coumadin)

bleeding precautions

28

If patient has a serum potassium level of 3.0 mEq/L complaining of anorexia, therapeutic serum level for digoxin is

Normal range = 0.5-2 ng/mL

29

Data indicate an adverse reaction associate with propanolol(Inderal)

Audible expiratory wheezes indicate bronchospasm. Beta blocker induce this reaction in patient with COPD / asthma.

30

Lab to order to monitor for a therapeutic effect of patient taking Heparin

Activated partial thromboplastin time (aPTT)

31

Teaching for Nitroglycerin ointment

Remove previous dose from skin. Squeeze a ribbon of ointment on prescribed length onto applicator paper. Spread ointment over 6x6 area using chest, back, abdomen, upper arm, anterior thigh + cover with plastic wrap. Rotate sites + avoid touching ointment.

32

Procainamide injection precautions

Monitor respiratory, BP, Pulse will be watched closely via ECG.
Contraindiation: AV block, lupus,history of "Long QT syndrome, congestive heart failure, circulation problems, a history of heart attack or stroke (including "mini-stroke"), a weak immune system, kidney or liver disease, myasthenia gravis, asthma, allergic to aspirin, sulfites, or any type of numbing medicine.

33

When to hold off administering digoxin

hold dose if pulse < 60 in adult or < 90 in infant

34

NI for administering colestipol

Do not take other medications . Taking colestipol can make it harder for your body to absorb certain drugs, making them less effective. Take your other medications at least 1 hour before or 4 hours after you take colestipol. Avoid constipation by drinking 8 to 12 full glasses (8 ounces each) every day

35

When to hold milrinone

heart failure or low levels of potassium in your blood (hypokalemia, digoxin, diuretic

36

Side effective of nitroglycerin CR

Severe allergic reactions (rash; hives; itching; difficulty breathing; tightness in the chest; swelling of the mouth, face, lips, or tongue); blurred vision; dry mouth; fainting; flushing; heavy sweating; irregular heartbeat; new or worsening chest pain; pale skin; pounding in the chest; rapid heartbeat; severe dizziness or headache; severe or persistent nausea or vomiting; shortness of breath; slow heartbeat; swelling of the hands, ankles, or feet; unusual weakness.

37

Heparin antidote

protamine

38

Digitalization of patient with cardiotonics

Rapid : administering loading dose
Gradual: maintenance dose allowing therapeutic drug blood levels to accumulate gradually
Additional fractions of digitalis dose given 6-8 hr intervals. Vitals Q 2-4 hr

39

Elevated level of homocysteine

Amino acid plays an important role of platelet aggregation. Risk factor for ischemic heart disease, cerebrovascular disease, peripheral arterial disease,venous thrombosis. Normal range: 4-14 mol/L

40

10 yr old rheumatic fever patient will develop what complication if untreated

Rheumatic heart disease (childhoood pharyngeal or upper respiratory tract infection)

41

NI for patient with history of 3 times CHF is noncompliance taking his meds

lab results

42

Edema/JVD/Abdominal distention/weight gain

Right Ventricular Failure

43

Protein released in MI

cardiac serum enzymes and troponin I

44

HTN patient using salt complain she can not lose 30 lbs.

sodium restriction diet

45

NI for patient with chest pain preoperative to cardiac catheterzation

pain management

46

defibrillation

termination of ventricular fibrillation by delivering a direct electrical counter shock to patient's precordium

47

Dx for ventricular gallup in adult

rates of 100 beats per minute or more due to an abnormal third or fourth heart sound being heard in addition to the first and second sounds. Also called gallop rhythm.

48

Signs/Symptoms of Buerger's disease

instep claudication, extremities may be cold, pale, ulcers and gangerene present. Sensitivity to cold.

49

Left ventricular failure assessment

Decreased cardiac output+pulmonary congestion = PE, dyspnea, wheezing, pink frothy sputum, pulmonary crackles/wheezing

50

Rationale for pacemaker in patient with 3rd degree block

regulate cardiac rhythm

51

Status post of cardiac canulation patient NI

...

52

Teaching for AVU

Lie still

53

Right ventricular failure

peripheral congestion. Peripheral edema.Distended jugular veins. Enlarge liver.Ascites.

54

NI for patient preoperative of heart transplant with anxiety

...

55

Positioning of left ventricle failure

sitting position with pillows or high fowler

56

Teaching of patient with coronary artery bypass graft (CABG)

...

57

Cardiac enzymes in MI episode

Troponin T: in the blood 3-5 hrs after an MI, remain elevated up to 21 days. Affected by muscle injury + renal disease
Troponin I: rises 3 hrs after MI, peaks at 14-18 hrs return to normal in 5-7 days
Myoglobin: present in muscle, may be non cardiac cause

58

CAD most risk factor

atherosclerosis

59

Common vessel use for CABG

saphenous veins in the leg, or internal mammary artery

60

Diet for patient taking Lasix

Patassium

61

Avoid in low sodium diet

Processed can food. Ketchup. Soy sauce

62

Type of disorder treat with pacemaker

Sinus Bradycardia

63

Digoxin toxicity

nausea, vomiting, anorexia, dysrhythmias, bradycardia, tachycardia, headache, fatigue, visual disturbances

64

Signs indicating renal perfussion in left ventricular failure

...

65

Valves preventing back flow to pulmonary artery

pulmonary semilunar valve

66

auscultate of patient's heart sound with pericarditis for

pericardial friction rub

67

Characteristic of normal sinus rhythm

Atrial + ventricular rhythms are at 60-100 bpm

68

Monitor patient taking Heparin

BUN

69

Holter monitor

evaluates effectiveness of antidysrhythmics or pacemaker therapy

70

NI for angina pectoris

promote comfort. promote tissue perfusion. promote activity & rest. relief of anxiety and well being.

71

Geriatric caution for digoxin

risk for fall. abdominal pain, anorexia, nausea, vomiting, visual disturbances, bradycardia, and other arrhythmias

72

Aortic stenosis manifestation

...

73

26 yrs old with cardiomyopathy due to

cocaine abuse = vasoconstriction hypertension=MI

74

NI for Clonergic antagonist

...

75

How heart contract

sympathetic nerve fibers releases the norepinephrine, increase heart rate, increase conduction speed through AV node, increased atrial +ventricular contractibility, and peripheral vasoconstriction, stimulation occurs when a decrease of pressure detected.

76

Rationale for giving propanalol for PTCA

block beta stimulation, decrease myocardial oxygen demand, decreasing myocardial damage

77

Pace maker teaching

Immobilized for first few hours. Not lift arm over head on he surgical side until given permission by MD. Monitor heart rate and rhythm by apical pulse.
Monitor vital signs +LOC

78

How to increase HDL

Diet and exercise. Low:<40 High:>60

79

NI Status post PTCA

monitor vital signs Q 30 min. monitor peripheral pulses, color, warmth, sensation. bleeding.extremity extended for 4-6 hr, keeping leg straight to prevent arterial occulsion. Fluid intake.

80

MRI side effects

claustraphobia while in the scanner

81

Sign/symptom of angina

substernal, squeezing pain, radiate to shoulder, arms, jaw, neck and back

82

NI status post patient with MI

bed rest first 24-36 hrs. ROM to prevent thrombus. Dangling legs at side of bed for 30/day. Ambulation 30 min 3X/Day

83

arterial occlusion disorder teaching

narrowing of artery in arthorslerosis, interupt blood flow to leg+feet=cramps

84

Cholesterol risk in cardiac disease factor

LDL Optimal: 100 High: 190

85

Hormone marker for CHF

BNP (Brain Natruetic peptide)

86

Malignant HTN

SDP > 250 DBP >130 bpm = renal failure, cerebral hemorrhage = life threatening

87

CAD modifying factors

Smoking. Blood pressure. Lipid level. Diabetes

88

Which BP reading is consider life threatening

>200/130 Diabetes: 130/80

89

Systolic vs Diastolic Pressure

Systole • Phase of contraction – systolic pressure(BP)– depolarization(EKG)
Diastole• Phase of relaxation – diastolic pressure(BP)–repolarization(EKG

90

Creatine Kinase(CK)

rise 4 to 8 hours, peaking at 16 to 30 hours and returning to baseline within 4 days.
Creatine Kinase (male) 25 - 90 U/L
Creatine Kinase (female) 10 - 70 U/L

91

(LDH) Lactate dehydrogenase

Total LDH rise 2 to 5 days after an MI; last 10 days.
LDH, serum: 45 - 90 U/L
LDH-1 and LDH-2 LDH isoenzymes - Compare LDH 1 and LDH 2 levels. Normally, the LDH-1 value will be less than the LDH-2. In the acute MI, however, the LDH 2 remains constant, while LDH 1 rises

92

Myoglobin

abnormal within 1 to 2 hours of necrosis, peaks in 4-8 hours, and drops to normal in about 12 hours.
(male): 10 - 95 ng/mL (female): 10 - 65 ng/mL

93

Troponin Complex

Peaks in 10-24 hours, begins to fall off after 1-2 weeks. Tropinin I: < 0.1 ng/mL Tropinin T: < 0.1 ng/mL

94

aortic stenosis

Cause by rheumatic fever. Breathlessness with activity. Chest pain, angina-type. Crushing, squeezing, pressure, tightness
Pain increases with exercise, relieved with rest
Under the chest bone, may move to other areas
Fainting, weakness, or dizziness with activity
Palpitations

95

Non-modifiable factors

• Family history
• Age
• Sex (gender)
• Race (heredity)


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