Adult Cardiac (Boards Review) Questions and Answers: A Comprehensive Exam Solution, Exams of Nursing

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what heart sound is heard when the AV valves close and semilunar valves open, it is "lub", and it is heard at the apex? - CORRECT ANSWERS S what heart sound is heard when the semilunar valves close and the AV valves open, it is "dub" and it is heard loudest at the base? - CORRECT ANSWERS S what is the period between S1 and S2? - CORRECT ANSWERS systole what is the period between S2 and S1 and it is relaxing? - CORRECT ANSWERS diastole what heart sound is "kentucky", it is heard in increased fluid states like heart failure and pregnancy? - CORRECT ANSWERS S what heart sound is "tennessee", it is a stiff ventricular wall, MI, left ventricular hypertrophy, and chronic hypertension? - CORRECT ANSWERS S what murmur sound is barely audible? - CORRECT ANSWERS grade I what murmur sound is audible but faint? - CORRECT ANSWERS grade 2 what murmur sound is moderately loud and easily heard? - CORRECT ANSWERS grade 3 what murmur sound is loud, associated with a thrill? - CORRECT ANSWERS grade 4 what murmur sound is very loud and it is heard with one corner of the stethoscope off of the chest wall? - CORRECT ANSWERS grade 5 what murmur sound is the loudest? - CORRECT ANSWERS grade 6 what is otherwise known as tubulent blood flow? - CORRECT ANSWERS murmur

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what is a loud S1 murmur, low pitched, mid diastolic, apical "crescendo" rumble? - CORRECT ANSWERS mitral stenosis what is a systolic murmur at the 5th ICS MCL (apex), it may radiate to the base or left axilla, it is musical, blowing, or high pitched, and it may follow an S3? - CORRECT ANSWERS mitral regurgitation what is a systolic "blowing" rough, harsh murmur at the 2nd right ICS usually radiating to the neck? - CORRECT ANSWERS aortic stenosis what is a diastolic "blowing" murmur at the 2nd left ICS? - CORRECT ANSWERS aortic regurgitation what is the pneumonic for valvular disease murmurs? - CORRECT ANSWERS MS ARDS (diastolic) MR. PASS (systolic) what valve is at the 5th ICS or apex? - CORRECT ANSWERS mitral what valve is at the 2nd or 3rd ICS or the base? - CORRECT ANSWERS aortic what is a crescendo decrescendo murmur that is at the base and midsystolic? - CORRECT ANSWERS aortic stenosis what is a pan diastolic murmur at the apex? - CORRECT ANSWERS mitral stenosis what type of murmur is mitral valve prolapse, diastolic or systolic? - CORRECT ANSWERS systolic what is a good ejection fraction? - CORRECT ANSWERS 60

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what is a syndrome that results when cardiac output is insufficient to meet the metabolic needs of the body, and it is either systolic or diastolic? - CORRECT ANSWERS heart failure what type of heart failure is HF with reduced ejection fraction? - CORRECT ANSWERS systolic what type of heart failure is HF with preserved ejection fraction? - CORRECT ANSWERS diastolic what type of HF is the inability to contract, it results in decreased cardiac output, and the left ventricular ejection fraction is between 40-49%? - CORRECT ANSWERS systolic HF what type of HF do we need an inotrope like entresto or something to make the heart squeeze? - CORRECT ANSWERS systolic HF what type of HF is inability to fill and relax, it results in a decreased cardiac output, and the left ventricular output is greater than 50%? - CORRECT ANSWERS diastolic HF what are the two different categories of HF? - CORRECT ANSWERS acute (left sided) chronic (right sided) what type of heart failure has an abrupt onset and it usually follows an acute MI or valve rupture? - CORRECT ANSWERS acute (left sided) what type of heart failure develops as a result of inadequate compensatory mechanisms that have been employed over time to improve cardiac output? - CORRECT ANSWERS chronic (right sided) what type of HF are these s/s of:

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lungs dyspnea at rest coarse rales over all lung fields wheezing frothy cough appears generally healthy minus the acute event S3 gallop murmur of mitral regurgitation? - CORRECT ANSWERS acute (left sided) what is the most needed valve replacement? - CORRECT ANSWERS mitral valve what type of HF is when the blood backs up from the left ventricle to the left atria and to the lungs? - CORRECT ANSWERS left sided what type of HF are these s/s of: JVD hepatomegaly splenomegaly dependent edema increased capillary hydrostatic pressure paroxysmal nocturnal dyspnea appears chronically ill fatigue on exertion S3 and/or S4? - CORRECT ANSWERS right sided what type of HF goes from the right ventricle to the right atria and then to JVD and hepatosplenomegaly? - CORRECT ANSWERS right sided

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what is the leading cause of right sided HF? - CORRECT ANSWERS left sided HF is cor pulmonale associated with right ventricular hypertrophy? - CORRECT ANSWERS yes what are the 4 New York Heart Association classifications of heart failure? - CORRECT ANSWERS I II III IV what NYHA class of heart failure is this: no limitations of physical activity, normal activity causes no s/s? - CORRECT ANSWERS class I what NYHA class of heart failure is this: slight limitations of physical activity but comfortable at rest physical activity results in fatigue, palpiations, dyspnea, or angina? - CORRECT ANSWERS class II what NYHA class of heart failure is this: marked limitations of physical activity but comfortable at rest 3 pillows? - CORRECT ANSWERS class III what NYHA class of heart failure is this: severe, inability to carry out any physical activity without discomfort s/s while at rest? - CORRECT ANSWERS class IV

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what are these labs/diagnostics for: hypoxemia hypocapnea BMP (normal) urinalysis BNP chest x ray echocaardiogram EKG PFTs for wheezing? - CORRECT ANSWERS heart failure what is present on a chest x ray for HF? - CORRECT ANSWERS pulmonary edema kerley B lines effusions what is the non pharamcologic management for HF? - CORRECT ANSWERS sodium restriction rest/activity balance weight loss what is the first line medication choice for all classes of heart failure? - CORRECT ANSWERS diuretics what medications are used to treat systolic heart failure? - CORRECT ANSWERS ACE inhibitors ARBS Angiotensin-receptor/neprilysn inhibitors (ARNIS) aka Entresto

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what are these used to treat: ACE inhibitors ARBS Angiotensin-receptor/neprilysn inhibitors (ARNIS) aka Entresto? - CORRECT ANSWERS systolic HF (HFrEF) what are some other recommended drugs used to treat systolic HF after diuretics, ACEI, ARBS, and ARNIs? - CORRECT ANSWERS SGLT2 inhibitors ("Gliflozin") beta blockers mineralcorticoid receptor antagonists what drugs are the mineralcorticoid receptor antagonists (MRAs) for HF? - CORRECT ANSWERS spironolactone (Aldactone) Eplerenone (Inspra) what is the drug treatments for diastolic (HFpEF) heart failure? - CORRECT ANSWERS diuretics SGLT2 inhibitors ARBS ARNIs MRAs what drugs are not strongle recommended to treat diastolic HF due to no change in outcome evidenced? - CORRECT ANSWERS ACE inhibitors what are the two types of hypertension? - CORRECT ANSWERS primary secondary

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what type of HTN is 95% of all cases and the onset is usually <55 years of age? - CORRECT ANSWERS primary/essential what type of HTN is 5% of all cases, it is secondary to other known causes such as estrogen use, renal disease, pregnancy, endocrine disorders, renal artery stenosis, etc? - CORRECT ANSWERS secondary what are some exacerbating factors for hypertension? - CORRECT ANSWERS smoking obesity excessive alcohol intake NSAIDS what type of HTN are the elderly most likely to have? - CORRECT ANSWERS white coat HTN what is otherwise known as the "silent killer"? - CORRECT ANSWERS hypertension what are these s/s of: often none aka "silent killer" elevated BP suboccipital pulsating headache in the AM that gets better during day dizziness lightheadness epistaxis S4 due to left ventricular hypertrophy AV nicking tearing chest pain (aortic dissection)? - CORRECT ANSWERS hypertension in uncomplicated hypertension, are lab findings usually normal? - CORRECT ANSWERS yes

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what tests do we do for hypertension? - CORRECT ANSWERS renovascular disease studies chest x ray (r/o cardiomegaly) plasma aldosterone (r/o aldosteronism) AM/PM cortisol (r/o cushings syndrome) urinalysis CBC BMP calcium phosphorous uric acid cholesterol triglycerides EKG PA and lateral chest x ray what are these labs/tests for: renovascular disease studies chest x ray (r/o cardiomegaly) plasma aldosterone (r/o aldosteronism) AM/PM cortisol (r/o cushings syndrome) urinalysis CBC BMP calcium phosphorous uric acid

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cholesterol triglycerides EKG PA and lateral chest x ray? - CORRECT ANSWERS hypertension what BP category is this: <120 AND <80? - CORRECT ANSWERS normal what BP category is this: 120-129 AND <80? - CORRECT ANSWERS elevated what BP category is this: 130-139 OR 80-89? - CORRECT ANSWERS stage 1 what BP category is this:

140 OR >90? - CORRECT ANSWERS stage 2 what is normal BP? - CORRECT ANSWERS <120 AND < what is elevated BP? - CORRECT ANSWERS 120-129 AND < what is stage 1 hypertension BP? - CORRECT ANSWERS 130-139 OR 80- what is stage 2 hypertension BP? - CORRECT ANSWERS >140 OR >

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what are the nonpharmacologic management for hypertension? - CORRECT ANSWERS low dietary sodium weight loss DASH diet exercise stress management reduction or elimination of alcohol smoking cessation maintain adequate potassium, calcium, and magnesium intake what are these nonpharmacologic management for: low dietary sodium weight loss DASH diet exercise stress management reduction or elimination of alcohol smoking cessation maintain adequate potassium, calcium, and magnesium intake? - CORRECT ANSWERS hypertension what is a dietary approach to stop hypertension that is a diet rich in fruits, veggies, low fat dairy products, and reduced saturated and total fat? - CORRECT ANSWERS DASH diet

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how much exercise should someone with HTN try to do? - CORRECT ANSWERS 30-40 mins each day on most days of the week how many drinks should men have a day? - CORRECT ANSWERS no more than 2 daily how many drinks should women have a day? - CORRECT ANSWERS 1 drink daily what is the pharmacologic management for non african americans (WHITE) with hypertension? - CORRECT ANSWERS thiazide diuretic ACE inhibitor ARB calcium channel blocker what is this the management for HTN for: thiazide diuretic ACE inhibitor ARB calcium channel blocker? - CORRECT ANSWERS white what is the management for HTN for african americans? - CORRECT ANSWERS thiazide diuretics calcium channel blockers what is the management for HTN for diabetics? - CORRECT ANSWERS ACE inhibitor or an ARB what is the management for adults >18 years old with CKD for hypertension? - CORRECT ANSWERS ACE inhibitor

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what drugs end in "PRIL"? - CORRECT ANSWERS ACE inhibitors what drugs end in "SARTAN"? - CORRECT ANSWERS ARBS what drugs end in "PINE"? - CORRECT ANSWERS calcium channel blockers what is the BP goal for everybody? - CORRECT ANSWERS less than 130/ is the treatment goal for HTN for initial treatment is one month, then (1) increase dose, followed by (2) adding a second drug? - CORRECT ANSWERS yes, and continue to assess monthly until goal is reached can you use an ACE and ARB together? - CORRECT ANSWERS NO, they can cause hyperkalemia do you need to refer to a hypertensive specialist if having difficulty reaching the goal and the patient is on 3 or more drugs? - CORRECT ANSWERS yes what drugs are usually recommended for 1st line treatment in hypertension and they may also protect against osteoporosis by reducing the amount of calcium expelled in the urine? - CORRECT ANSWERS thiazide diuretics what is decreased blood flow through the vessel that leads to tissue ischemia? - CORRECT ANSWERS angina what are the 3 different types of angina? - CORRECT ANSWERS stable prinzmetal (variant) unstable what type of angina is exertional and it is the most common? - CORRECT ANSWERS stable (classic or chronic)

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what type of angina occurs at various times including rest? - CORRECT ANSWERS prinzmetals (variant/vasospastic) what type of angina happens in someone that takes CCBs and they have ST segment elevation? - CORRECT ANSWERS prinzmetals (variant/vasospastic) what type of angina is coronary syndromes? - CORRECT ANSWERS unstable what does ST segment look like in angina? - CORRECT ANSWERS ST segment depression what are these s/s of: characteristic chest discomfort lasting several mins exertional is preciptated by physical activity and subsides with rest nitrogylcerin shortens or prevents attacks levines sign? - CORRECT ANSWERS angina what drug shortens or prevents attacks of angina? - CORRECT ANSWERS nitroglycerin what is a "clenched fist sign" that is right over the chest for angina? - CORRECT ANSWERS levines sign what is plaque build up in the walls? - CORRECT ANSWERS atherosclerosis what does an EKG look like in angina? - CORRECT ANSWERS may be normal with ST segment depression or T wave peak or inversion should you check lipid levels in angina? - CORRECT ANSWERS yes

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what is normal total cholesterol? - CORRECT ANSWERS less than 200 what is normal VLDLs (triglycerides)? - CORRECT ANSWERS less than 150 what is normal LDLs? - CORRECT ANSWERS less than 100 what are normal HDLs? - CORRECT ANSWERS low= less than 40 high= greater than 60 what LDL is the goal for patients with diabetes or documented CAD? - CORRECT ANSWERS LDL < 70 what is this management for: reduce risk factors diet low in saturated fats, low in unsaturated fats baby Aspirin (81 mg daily) nitrates beta blockers calcium channel blockers? - CORRECT ANSWERS angina what is the management for angina? - CORRECT ANSWERS reduce risk factors diet low in saturated fats, low in unsaturated fats baby Aspirin (81 mg daily) nitrates beta blockers calcium channel blockers

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what is done to estimate 10 year atherosclerotic cardiovascular disease (ASCVD) risk and it is defined as the first occurence of nonfatal and fatal MI, and nonfatal and fatal stroke? - CORRECT ANSWERS pooled cohort equations to identify candidates for statin therapy, what is the estimated risk of ASCVD based on? - CORRECT ANSWERS age sex race total cholesterol HDL cholesterol systolic BP diabetes status smoking status what are these components for: age sex race total cholesterol HDL cholesterol systolic BP diabetes status smoking status? - CORRECT ANSWERS pooled cohort equation for ASCVD who might benefit from statin therapy? - CORRECT ANSWERS clinical evidence of ASCVD elevated LDL >

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diabetics age 40-75 with LDL between 70-189 without clinical evidence of ASCVD without ASCVD or diabetes with LDL between 70-189 but with an estimated 10 year ASCVD risk of 7.5% or higher what lab do you need to monitor when starting statins? - CORRECT ANSWERS LFTs what type of statin lowers LDL by greater than 50%? - CORRECT ANSWERS high intensity what type of statin lowers LDL by 30 to 50%? - CORRECT ANSWERS moderate intensity what type of statin lowers LDL by less than 30%? - CORRECT ANSWERS low intensity what are the high intensity statins? - CORRECT ANSWERS Atorvastatin (40-80) Rosuvastatin (20-40) what type of statins are these: Atorvastatin (40-80) Rosuvastatin (20-40)? - CORRECT ANSWERS high intensity what are the moderate intensity statins? - CORRECT ANSWERS Atorvastatin (10-20) Rosuvastatin (5-10) Simvastatin (20-40) Pravastatin (40-80) Lovastatin (40) Fluvastatin (80) Pitavastatin (2-4)

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what type of statins are these: Atorvastatin (10-20) Rosuvastatin (5-10) Simvastatin (20-40) Pravastatin (40-80) Lovastatin (40) Fluvastatin (80) Pitavastatin (2-4)? - CORRECT ANSWERS moderate intensity what are the low intensity statins? - CORRECT ANSWERS Simvastatin (10) Pravastatin (10-20) Lovastatin (20) Fluvastatin (20-40) Pitavastatin (1) what type of statins are these: Simvastatin (10) Pravastatin (10-20) Lovastatin (20) Fluvastatin (20-40) Pitavastatin (1)? - CORRECT ANSWERS low intensity what drug do you add when you maxxed out on statins? - CORRECT ANSWERS zetia

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what are commonly used agents other than statins? - CORRECT ANSWERS bile acid sequestrants fibrates cholesterol absorption inhibitor niacin what are the bile acid sequestrant drugs? - CORRECT ANSWERS cholestyramine (Questran) colesevelam (Welchol) colestipol (Colestid) what type of drugs are these: cholestyramine (Questran) colesevelam (Welchol) colestipol (Colestid)? - CORRECT ANSWERS bile acid sequestrants what type of drugs mostly lower LDL, but may increase triglycerides? - CORRECT ANSWERS bile acid sequestrants what type of drugs lower tricglycerides, slightly lower LDL, and may raise HDL? - CORRECT ANSWERS fibrates what type of drugs are these: gemfibrozil (Lopid) fenofibrate (Tricor) fenofibrate acid (Trilipix)? - CORRECT ANSWERS fibrates what are the fibrate drugs? - CORRECT ANSWERS gemfibrozil (Lopid)

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fenofibrate (Tricor) fenofibrate acid (Trilipix) what is the cholesterol absorption inhibitor drug that is used in combination with a statin to lower LDL? - CORRECT ANSWERS ezetimibe (Zetia) what drug lower LDL and triglycerides, but increases HDL? - CORRECT ANSWERS niacin what do high doses of the drug "Niacin" cause? - CORRECT ANSWERS flushing sesnation what is contributing to the leading cause of death in adults in the US (heart disease) and it is a clot on plaque that can cause sudden cardiac death from CAD or cardiomyopathies? - CORRECT ANSWERS MI/ acute coronary syndromes what are the EKG changes like for an MI? - CORRECT ANSWERS ST segment elevation peaked T waves Q wave development what does SALI stand for in EKG leads? - CORRECT ANSWERS Septal (V1, V2) Anterior (V3, V4) Lateral (I, AvL) Inferior (II, III, AVF) what are the 3 cardiac enzyme elevations? - CORRECT ANSWERS troponin T troponin I CK-MB what are tehse examples of:

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Septal (V1, V2) Anterior (V3, V4) Lateral (I, AvL) Inferior (II, III, AVF)? - CORRECT ANSWERS SALI EKG leads what are the septal EKG leads? - CORRECT ANSWERS V1 V2 what are the anterior EKG leads? - CORRECT ANSWERS V3 V4 what are the lateral EKG leads? - CORRECT ANSWERS I, AVL, V5, V6 what are the inferior EKG leads? - CORRECT ANSWERS II, III, AVF what does unrelieved chest pain for more than 30 minutes and less than 6 hours WITH ST segment elevation in two or more contigious leads mean? - CORRECT ANSWERS pharmacologic revascularization needed what do you give if you gave too much coumadin? - CORRECT ANSWERS vitamin K what do you give if you gave too much heparin? - CORRECT ANSWERS protamine what are absolute contraindications for revascularization with an MI? - CORRECT ANSWERS active bleeding abnormal coagulation values what is an inflammation of the pericardium, a thorough history is needed to make an accurate diagnosis, and viruses are the most common cause? - CORRECT ANSWERS pericarditis

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what are these s/s of: very localized retrosternal/precordial chest pain, pleuritic in nature pain increased by deep inspiration, coughing, swallowing, or recumbent pain releived by sitting forward! SOB secondary to pain with inspiration pericardial friction rub present ST segment elevation in ALL leads? - CORRECT ANSWERS pericarditis what are these labs/diagnostics for: ST segment elevation in ALL leads return of ST segment to normal in a few days with temporary T wave inversion depression of PR segment high ESR blood cultures CBC echocardiogram baseline BMP? - CORRECT ANSWERS pericarditis what drugs are the mainstay of treatment for pericarditis? - CORRECT ANSWERS NSAIDS -indomethacin (Indocin) -Ketorolac (Toradol) -Ibuprofen (Motrin, Advil) what drugs are indicated for pericarditis only when there is a total failure of high dose NSAIDS over several weeks with relapsing pericarditis, and they can increase viral replication? - CORRECT ANSWERS corticosteroids

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are antibiotics used for bacterial infection causes of pericarditis? - CORRECT ANSWERS yes what do you need to monitor for with pericarditis? - CORRECT ANSWERS cardiac tamponade what is when there is: hypotension JVD high central venous pressure muffled/distant heart sounds pulsus paradoxus? - CORRECT ANSWERS cardiac tamponade what are the s/s of cardiac tamponade? - CORRECT ANSWERS hypotension JVD high central venous pressure muffled/distant heart sounds pulsus paradoxus what is arteriosclerotic narrowing of the lumen of the arteries resulting in decreased blood supply to the extremities that is usually caused by atherosclerosis, hyperlipidemia, smoking, and diabetes, and the peak age is usually 40 to 70 years old? - CORRECT ANSWERS peripheral vascular disease (PAD) what is impaired venous return due to either destruction of valves, changes due to deep thrombophlebitis, leg trauma, or sustained elevation of venous pressure, it is more common in women, may have a genetic predisposition, and it may be associated with a hx of leg trauma and varicose veins? - CORRECT ANSWERS chronic venous insufficiency what has s/s of:

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calf pain (claudication) cold/numbness to extremities progresses to pain at rest shiny hairless skin dependent rubor pallor cyanosis ulcerations reduced pulses? - CORRECT ANSWERS PAD what are s/s of PAD? - CORRECT ANSWERS calf pain (claudication) cold/numbness to extremities progresses to pain at rest shiny hairless skin dependent rubor pallor cyanosis ulcerations reduced pulses what are labs/diagnostics for PAD? - CORRECT ANSWERS doppler US ankle brachial index (ABI) x rays arteriography what is the most definitive test for PAD? - CORRECT ANSWERS arteriography

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what are these s/s of: aching of lower extremities that is relieved by elevation edema after prolonged standing night cramps brownish discoloration stasis leg ulcers edema of lower extremities dermatitis cool to touch? - CORRECT ANSWERS CVI are there any specific tests done to diagnose chronic venous insufficiency other than ruling out edema due to heart failure and other causes? - CORRECT ANSWERS no what is the management for PAD? - CORRECT ANSWERS stop smoking exercise (walk 1 hour a day) Cilostazol (Pletal) w aspirin or plavix Pentoxifylline (Trental) weight reduction manage diabetes/hyperlipidemia angioplasty bypass surgery amputation what are these management for: stop smoking exercise (walk 1 hour a day)