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Adult Health exam 3 ALL VERSIONS 2025 |
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Which is the correct hold parameter for digoxin? A. Hold if HR >100 bpm B. Hold if HR <60 bpm ✔ C. Hold if BP <100/60 mmHg D. Hold if respiratory rate <12/min Rationale: Digoxin should be held if HR <60 bpm because bradycardia is a sign of toxicity. Toxicity may also cause GI upset, tremors, and yellow/amber vision. Furosemide Consideration What should be assessed before administering furosemide? A. Respiratory rate B. Blood pressure, volume status, and electrolytes ✔ C. Reflexes D. Heart sounds Rationale: Furosemide is a loop diuretic that can cause fluid/electrolyte imbalances and hypotension, so BP, volume, and electrolytes should be assessed first. Nitroglycerin Considerations Before giving nitroglycerin, the nurse should: A. Assess lung sounds B. Check bowel sounds C. Check blood pressure ✔ D. Check reflexes
Rationale: Nitroglycerin may cause hypotension and headache. Always check BP before administration. DASH Diet Which food pattern describes the DASH diet? A. High protein, low fat B. High in fruits, vegetables, whole grains, low-fat dairy ✔ C. High in red meat and sodium D. Low in fiber, high in processed foods Rationale: The DASH diet promotes heart health with fruits, vegetables, whole grains, and low- fat dairy, while limiting sodium, saturated fat, processed foods, and added sugars. Cardiac Tissue Injury What happens when cardiac muscle tissue is destroyed? A. It regenerates fully B. It scars and may disrupt conduction ✔ C. It hypertrophies and restores function D. It becomes ischemic but reversible Rationale: Cardiac tissue does not regenerate; once destroyed, it forms scar tissue that may disrupt electrical conduction. Cardiac Conduction Pathway Which sequence is correct for the cardiac conduction pathway? A. AV node → SA node → Purkinje fibers B. SA node → AV node → Bundle of His → Bundle branches → Purkinje fibers ✔ C. Purkinje fibers → SA node → AV node D. SA node → Bundle of His → AV node Rationale: The SA node initiates impulses, which travel through AV node, Bundle of His, bundle branches, and Purkinje fibers. Heart Wall Layers (outer to inner) What is the correct order of the heart wall layers? A. Endocardium → Myocardium → Epicardium → Pericardium B. Pericardium → Epicardium → Myocardium → Endocardium ✔
D. Atrial repolarization Rationale: The T wave indicates ventricular repolarization (relaxation). Stroke Volume Stroke volume is best defined as: A. The total blood pumped in one minute B. The force/volume of blood ejected with each beat ✔ C. The pressure exerted by the ventricles D. The preload and afterload combined Rationale: Stroke volume is the amount of blood ejected by the left ventricle with each contraction. Determinants of Stroke Volume Which factors determine stroke volume? A. Pulse pressure, HR, SVR B. Preload, contractility, afterload ✔ C. Oxygenation, preload, capillary refill D. Electrolytes, preload, murmur presence Rationale: Stroke volume is determined by preload (venous return), contractility (squeeze strength), and afterload (arterial resistance). Compensatory Response to Low BP If blood pressure drops, what is the typical compensatory response? A. Heart rate decreases B. Heart rate increases ✔ C. Respirations slow D. Cardiac output decreases Rationale: A fall in BP triggers increased HR (if CNS is intact) to maintain perfusion. Vascular Assessment Which is the correct method of vascular assessment? A. Assess only the affected limb B. Compare bilaterally and assess color, baseline, lesions, and drainage ✔ C. Assess radial pulse only
D. Check capillary refill only Rationale: Vascular assessment includes bilateral comparison, color, lesions, and drainage to detect abnormalities. Mottling Mottling of the skin is best described as: A. A normal finding in healthy patients B. A late and concerning finding, often preterminal ✔ C. An early sign of adequate perfusion D. An indication of hypothermia only Rationale: Mottling usually indicates poor circulation and is often seen in critical or preterminal states. Heart Sounds Which heart sounds are considered normal? A. S1 and S2 ✔ B. S3 and S C. Only S D. Only S Rationale: S1 and S2 are normal heart sounds. S3 and S4 are extra sounds that may indicate advanced heart disease. Pericardial Friction Rub A pericardial friction rub is most associated with: A. Endocarditis B. Myocarditis C. Pericarditis ✔ D. Valve stenosis Rationale: A pericardial friction rub suggests pericarditis due to inflamed pericardial layers rubbing together. Murmurs Cardiac murmurs are usually caused by: A. Hypertension
B. Troponin ✔ C. CK-MB D. BNP Rationale: Troponin is highly specific and rises quickly with myocardial injury, making it the preferred marker. Inflammation Marker Which laboratory value indicates systemic inflammation? A. BNP B. Troponin C. C-reactive protein (CRP) ✔ D. LDL Rationale: C-reactive protein increases with systemic inflammation, often elevated in cardiovascular disease. Coagulation Labs What is the therapeutic INR range for patients on warfarin? A. 0.5–1. B. 1.0–2. C. 2.0–3.5 ✔ D. 5.0–6. Rationale: Therapeutic INR for anticoagulation is 2.0–3.5. Heparin monitoring uses aPTT/PTT (60–80 sec). ABG & Heart Failure How does heart failure affect ABGs? A. It always causes alkalosis B. Fluid overload stretches myocardium and may cause acid-base changes ✔ C. It prevents oxygen delivery but not CO₂ retention D. It has no effect on ABGs Rationale: Fluid overload in HF can impair gas exchange and cause acid-base imbalances during exacerbations.
Heart Failure Red Flags Which is a key red flag for worsening heart failure? A. Mild cough B. Rapid weight gain (e.g., 10 lb in 3 days) ✔ C. Constipation D. Warm extremities Rationale: Rapid weight gain, SOB, orthopnea, and BNP >100 are warning signs of HF exacerbation. 12 - Lead ECG vs Telemetry What is the main purpose of telemetry compared to a 12-lead ECG? A. Telemetry diagnoses ischemia B. Telemetry is for continuous monitoring ✔ C. 12-lead is used for long-term monitoring D. Telemetry shows all ischemic changes Rationale: A 12-lead ECG diagnoses rhythm and ischemia; telemetry provides continuous rhythm monitoring. Mean Arterial Pressure (MAP) What MAP is needed for adequate organ perfusion? A. >50 mmHg B. >60 mmHg C. >70 mmHg ✔ D. >90 mmHg Rationale: A MAP >70 mmHg is generally required to maintain organ perfusion. Central Venous Pressure (CVP) A CVP of >6 cm H₂O indicates: A. Normal volume status B. Hypovolemia C. Volume overload ✔ D. Low cardiac output Rationale: CVP <2 = hypovolemia, 2–3 = normal, >6 = fluid overload.
Sinus Bradycardia The primary concern in sinus bradycardia is: A. High fever B. Slow HR <60 bpm ✔ C. Increased afterload D. Increased preload Rationale: Sinus bradycardia (<60 bpm) can cause poor perfusion. If unstable, treat with atropine or pacing. Sinus Tachycardia Which is the best initial management for sinus tachycardia? A. Give atropine B. Perform defibrillation C. Identify and treat the cause ✔ D. Insert a pacemaker Rationale: Sinus tachycardia (>100 bpm) is often secondary to fever, dehydration, pain, or anxiety. Treat the cause. Premature Ventricular Contractions (PVCs) A run of >4 PVCs in a row is considered: A. Sinus bradycardia B. Atrial fibrillation C. Ventricular tachycardia ✔ D. Normal Rationale: PVCs are wide and bizarre QRS complexes. >4 in a row = ventricular tachycardia. Ventricular Tachycardia (VTach) If a patient is in VTach and pulseless, what is the priority? A. Start IV fluids B. Administer oxygen and monitor C. Start CPR and defibrillate ✔ D. Administer atropine Rationale: Pulseless VTach is treated as a cardiac arrest: CPR and defibrillation immediately.
Ventricular Fibrillation (VFib) What is the appropriate action for ventricular fibrillation? A. Give atropine B. CPR and immediate defibrillation ✔ C. Monitor only D. Check electrolytes Rationale: VFib is a lethal rhythm with no cardiac output. CPR and defibrillation are required. Pulseless Electrical Activity (PEA) What is the correct treatment for PEA? A. Defibrillation immediately B. CPR and treat reversible causes ✔ C. Atropine and pacing D. Give nitroglycerin Rationale: In PEA, there is electrical activity without a pulse. It is non-shockable; treatment is CPR and correction of reversible causes (e.g., hypoxia, hypovolemia). Asystole What is the first priority in asystole? A. Defibrillation B. CPR and treat reversible causes ✔ C. Immediate synchronized cardioversion D. Give nitroglycerin Rationale: Asystole is a flatline rhythm with no electrical activity. It is non-shockable, requiring CPR and treatment of reversible causes. Arteriosclerosis vs Atherosclerosis Which statement best differentiates arteriosclerosis from atherosclerosis? A. Arteriosclerosis is plaque buildup; atherosclerosis is stiffening of vessels B. Arteriosclerosis is natural stiffening; atherosclerosis is plaque buildup ✔ C. Both terms mean the same thing D. Arteriosclerosis occurs only in veins Rationale: Arteriosclerosis = natural stiffening with age; Atherosclerosis = plaque deposits (main cause of CAD).
Anticoagulants/Antithrombotics Which lab is used to monitor warfarin therapy? A. aPTT B. INR ✔ C. CK-MB D. Troponin Rationale: Warfarin affects INR (therapeutic 2–3.5). Heparin affects aPTT (60–80). Apixaban does not require routine monitoring but takes ~3 days to clear. Stress Test What is the purpose of a cardiac stress test? A. To increase patient fitness B. To provoke ischemia for diagnosis ✔ C. To replace cardiac catheterization D. To measure electrolytes Rationale: Stress testing (treadmill or chemical) reproduces ischemia to justify cath lab intervention. Women’s MI Presentation Which is a common atypical MI presentation in women? A. Crushing chest pain B. Pain radiating to back or between shoulder blades ✔ C. Sharp RUQ abdominal pain only D. Severe nosebleeds Rationale: Women may have atypical symptoms such as low back pain or interscapular pain instead of classic chest pain. PCI/Angioplasty What is typically placed during PCI? A. Pacemaker B. Stent ✔ C. Catheter ablation line D. Swan-Ganz catheter
Rationale: PCI involves angioplasty and stent placement to restore coronary perfusion. Patients usually recover in PACU post-procedure. ECG Infarct Territories Which coronary artery is most commonly involved in an anterior wall MI? A. RCA B. LAD ✔ C. Circumflex D. Left main Rationale: Anterior MI usually involves the LAD, which supplies the left ventricle — high risk of complications. Post-MI Changes What happens to the myocardium after MI? A. It regenerates in 7–10 days B. It scars permanently with functional loss ✔ C. It hypertrophies and fully restores CO D. It undergoes reversible ischemia only Rationale: Post-MI, the myocardium forms scar tissue that does not regenerate, leading to permanent loss of function. CABG Overview What is the purpose of CABG surgery? A. Valve repair B. Bypass blocked coronary arteries ✔ C. Prevent atrial fibrillation D. Reduce cholesterol Rationale: CABG is performed when PCI is high-risk or unsuccessful, using grafts to bypass blocked vessels. CABG Graft Sites Which vessel is commonly used for CABG grafting? A. Jugular vein B. Greater saphenous vein ✔
B. High HDL C. Low preload D. Mild dehydration Rationale: Common HF causes include MI, arrhythmias, stimulant/drug use, and chronic volume/pressure overload. Diastolic Heart Failure What characterizes diastolic HF? A. Dilated thin ventricles B. Thick stiff ventricles with ↓ filling ✔ C. Increased contractility D. Complete ventricular regeneration Rationale: Diastolic HF occurs when stiff, thickened ventricles impair filling, leading to ↓ cardiac output. BLS: Compression Rate - answer_100-120/min. BLS: Hand Placement - answer_Lower half of sternum at the nipple line. BLS: Compression Depth - answer_2 inches (5 cm) in adults. BLS: Full Chest Recoil - answer_Allow full recoil between compressions. BLS: Pause Limit - answer_Minimize pauses; do not stop >10 seconds for checks. BLS: Pads While Compressing - answer_Do NOT stop compressions to place pads; work around the compressor. BLS: When Compressor Stops - answer_Pulse check, rhythm check, defibrillation only.
CPR Perfusion Window - answer_Takes ~8 seconds to build adequate perfusion; avoid time off chest. Arteriosclerosis vs Atherosclerosis - answer_Arteriosclerosis = vessel stiffening with age; Atherosclerosis = plaque buildup (modifiable risk factor target). Cardiac Risk Factors (Non-modifiable) - answer_Age, sex, genetics/family history, race/ethnicity. Cardiac Risk Factors (Modifiable) - answer_BP control, diabetes control, diet, smoking cessation, exercise, weight. Stable vs Unstable Angina - answer_Stable: predictable, relieved by rest/nitro. Unstable: at rest/unpredictable, not relieved by nitro. NSTEMI vs STEMI on ECG - answer_NSTEMI: ST depression/T-wave inversion. STEMI: ST elevation. Order of Meds for Chest Pain - answer_Oxygen → Nitroglycerin → Aspirin (morphine per orders if MI pain persists). Hold Cardiac Meds - answer_With low BP or low HR as specified for drug. Systolic HF - answer_Dilated/floppy ventricle; impaired squeeze → ↓ CO. Left-Sided HF - answer_↓ systemic perfusion; pulmonary edema, pink frothy sputum, SOB, orthopnea; renal hypoperfusion (↓ UO, prerenal AKI, RAAS).
Pink Puffer - answer_Emphysema Ciliary function is reduced, bronchial walls thicken, bronchial airways narrow and mucous may plug airways - answer_chronic bronchitis Blue bloater - answer_chronic bronchitis Chronic mucus hypersecretion causes lung function_________, ____________, and ____________ - answer_decline, exacerbation, infection Condition in which the body does not make enough of a protein that protects lungs and liver from damage - answer_Alpha 1 antitrypsin (AAT) Primary Symptom of Chronic bronchitis - answer_cough primary symptom of emphysema - answer_dyspnea Amount of sputum in bronchitis - answer_copious amount of sputum in emphysema - answer_scant Cor pulmonale is common with - answer_bronchitis (peripheral edema, increase JVD, hepatomegaly) Patients with emphysema have_________ - answer_barrel chest
Bronchitis or Emphysema have decreased recoil - answer_Emphysema Used to diagnose URI - answer_sputum cultures and WBC Medical management for COPD - answer_smoke cessation, bronchodilaters, inhaled corticosteroids, pulmonary rehab, O2, surgery Rapid relief bronchodilator - answer_ALbuterol Increase bronchodilation and decrease pulmonary secretions - answer_atrovent relaxes smooth muscles of the bronchi - answer_theophylline inhaled and systemetic medication Decrease airway inflammation - answer_corticosteroids inahler to suppress inflammation of airway - answer_flovent (corticosteroids) decrease inflmmatory process in asthma and allergic rhinitis - answer_Singulair (corticosteroids) Prevents release of inflammatory chemicals- histamine from mast cells - answer_cromolyn sodium Types of corticosteroids - answer_Flovent, singulair, prednisone, cromolyn sodium helps slow exhalation and prevent collapse of the small airways. Allows more aire to be exhaled and decreased hyperinflation - answer_pursed lip breathing
