NR 545 EXAM 3 LATEST 2024-2025 ACTUAL EXAM STUDY GUIDE WITH QUESTIONS AND CORRECT ANSWERS, Exams of Nursing

Download NR 545 EXAM 3 LATEST 2024-2025 ACTUAL EXAM STUDY GUIDE WITH QUESTIONS AND CORRECT ANSWERS and more Exams Nursing in PDF only on Docsity! NR 545 EXAM 3 LATEST 2024- 2025 ACTUAL EXAM STUDY GUIDE WITH QUESTIONS AND CORRECT ANSWERS WITH RATIONALES| ALREADY GRADED A+ NR 545 EXAM 3 What is Angina? Angina, or angina pectoris, is often described as chest pain usually precipitated by stress or exertion and relieved rapidly with rest or nitrates. Those with angina report varying symptoms including chest pain categorized as squeezing while others describe the pain like a During a myocardial infarction there is an imbalance between myocardial oxygen supply and demand. Prolonged ischemia (>30 minutes) from the lack of circulating blood flow to the myocardium results in cellular death, further impacting the heart's ability to function. Depending on the extent of the cell death, the heart might have decreased contractility resulting in wall function abnormalities further placing the patient at risk for decompensation. What are the symptoms of a Myocardial Infraction? - Sharp radiating pain (Even at rest) - Light-headed or have increased feelings of anxiety or impending doom. - Nausea (more common in right coronary artery occlusion) - Vomiting - Diaphoresis - Syncope - Dyspnea - Orthopnea - Wheezing What lab test are needed for a Myocardial Infraction? - Troponins - CK-MB - An ECG will often demonstrate ST-segment elevation or new left bundle branch block. How do you manage a Myocardial Infraction? Patients presenting with acute myocardial infarction will need reperfusion therapy or fibrinolytic therapy. To decrease mortality rates, reperfusion through PCI needs to be completed within 90 minutes of presentation to the emergency room. What is Atherosclerosis? a disease of the arteries characterized by the deposition of plaques of fatty material on their inner walls. What is the path of Atherosclerosis? Atherosclerosis is an inflammatory process that begins with damage to the endothelium often the result of hypertension, smoking, high cholesterol or other risk factors. The endothelium develops a fatty streak which further develops into a fibrous plaque and then complicated lesion. Physical assessment of Atherosclerosis? Family medical history and personal medical history should be reviewed for risk factors, including level of physical activity, tobacco, use, and dietary habits. A review of symptoms including recent and increasing fatigue, as well as fluid retention should be completed. A medication history should be obtained to determine risk factors including high cholesterol, hypertension, or diabetes. While a full physical assessment should be performed, particular attention to pulse deficits, neck vein distention, edema, and calf pain can further contribute to the diagnosis. What are test of Atherosclerosis? - Stress tests (either exercise or pharmacological) - Chest x-ray - 12-lead ECG - Ankle-Brachial index might also be performed to assess blood pressure in the extremities. What is the pharmacologic management of Atherosclerosis? - Antiplatelet medications (Aspirins) - Statins - ACE) inhibitors What are Arrhythmias? irregular heart rhythms; uncoordinated atrial and ventricular contractions What is a bradyarrhythmia? slow irregular heart rate what is Ventricular tachycardia? can be dangerous when it lasts for any considerable length of time. Furthermore, this rhythm can advance into more serious rhythms such as ventricular fibrillation. What is ventricular fibrillation? The result of unorganized electrical impulses that result in the ventricles quivering instead of creating a full contraction to pump the blood out of the heart. In this scenario, sudden cardiac arrest and death is possible within just a few minutes. Symptoms of ventricular arrhythmias: - Palpitation or the feeling of a skipped beat or their heart racing - Anxiety - Vision changes - Chest pain - Dyspnea - Syncope - Fatigue - Diaphoresis - Dizziness Physical assessment findings that may be seen with an arrhythmia include - dependent edema: - Irregular pulses - Heart murmur - Thyroid abnormalities Lab test for ventricular arrhythmias: - Electrocardiogram - Chest x-ray - Once confirmed, lab values to consider ordering include thyroid stimulating hormone and electrolytes such as potassium, magnesium, calcium, and sodium. - echocardiogram - cardiac CT scan - cardiac monitor - loop recorder - sleep study, or a stress test What are Pharmacologic Management for ventricular arrhythmias? There is not a singular first line treatment for arrhythmia. What is heart failure? Heart failure is a complex clinical syndrome that results from structural or functional impairment of ventricular filling or ejection of blood, which in turn leads to the cardinal clinical symptoms of dyspnea and fatigue, edema, and rales. Because many patients present without signs or symptoms of volume overload, the term heart failure is preferred over the older term Congestive heart failure. What is class 1 heart failure? no limit to physical activity, ordinary physical activity without symptoms What is class 2 heart failure? slight limit to physical activity, comfortable at rest, Ordinary physical activity results in fatigue, palpitation, dyspnea, or anginal pain. What is class 3 heart failure? marked physical activity limit, comfy at rest, less than ordinary physical activity has symptoms of fatigue, palpitation, dyspnea, or anginal pain. What is class 4 heart failure? Inability to carry on any physical activity without discomfort. Discomfort is increased with any physical activity What is stage A of heart failure? Heart disease risk, no structural changes - B-type natriuretic peptide (BNP) and N-Terminal pro-BNP (NT- proBNP) are released from a failing heart and a sensitive marker for the presence of HF - Newer markers, soluble ST-2, and galectin-3 are used to determine the prognosis of HF patients - Chest X-ray - Electrocardiogram 12-lead - Echocardiogram two-dimensional (2-D) assessment of LV size and function, - MRI is the gold standard for assessing LV mass and volume What are the pharmacological management of heart failure? Asymptomatic Treatment: - Ace Inhibitor - Venous/Arterial vasodilation. Drug/Dosing: Enalapril 2.5mg three times a day - Angiotensin II Receptor Blocker - Venous/Arterial vasodilation. Drug/Dosing: Losartan 25-40mg per day Symptomatic Treatment: - Beta Blockers - Blocks receptors of adrenergic nervous system. Drug/Dosing: Coreg 6.25-25mg twice a day - HCN Channel Blockers - Blocks Hyperpolarization-Activated Cyclic Nucleotide-Gated Channel (HCN) in SA node to decrease heart rate. Drug/Dosing: Corlanor 5mg twice a day for two weeks, then 5mg per day - Diuretics - Inhibits sodium chloride reabsorption. Drug/Dosing: HCTZ 12.5-50mg per day Drug/Dosing: Lasix 20-80mg per day - Antiarrhythmics - Inhibits sodium-potassium ATPase. Drug/Dosing: Digitalis 3.4-5.1mcg/kg per day What are the uses of Nitroglycerin? Angina attacks and prophylaxis How does Nitroglycerin work? Reduces cardiac workload, acts as a peripheral and coronary vasodilator What are the common adverse effects of Nitroglycerin? Dizziness and headache What are the uses of Metoprolol? Hypertension, angina, antiarrhythmic How does Metoprolol work? It blocks beta adrenergic receptors and slows heart rate What are the common adverse effects of Metoprolol? Dizziness and fatigue Nifedipine (Adalat) Uses: Angina, HTN, Peripheral Vasodilator, antiarrhythmic Action: Calcium Channel blocker Adverse effects: N/V, fatigue, headache, weakness Digoxin uses.. CHF, Atrial arrhythmias Ho dose Digoxin work? Slows conduction through AV node and increases force of contraction to increase efficiency Adverse effects of Digoxin... N/V, fatigue, headache, weakness Uses for enalapril HTN What are test for migraine headaches? - Head CT for: First or worst migraine New or unexplained neurologic symptoms New onset headaches in patients with cancer or HIV infection Episodic headache with hypertension, palpitations, and diaphoresis Associated symptoms: fever, stiff neck, papilledema, cognitive impairment, personality change New onset headache after 50 years of age - (MRI) can be used when there is a suspicion of posterior fossa lesions or cerebrospinal fluid (CSF) leak is suspected. Magnetic Resonance Angiography (MRA) and Magnetic Resonance Venography (MRV) are indicated when arterial or venous lesions are suspected. What meds are needed for migraine headaches? For mild - NSAIDS - Acetaminophen - Caffeinated analgesic combinations (e.g. aspirin+acetaminophen + caffeine) For severe - Dihydroergotamine - Triptans - Serotonin - Sumatriptan (3, 4 or 6 mg SC and intranasal and inhaled powder formulations) Almotriptan, Eletriptan, Naratriptan, Rizatriptan, Zolmitriptan - Ubropegant (Ubrelvy) and erenumab-aooe (Aimovig) - Lasmiditan What is a tension headache? Most common type of headache, dull ache, nondescript, usually not associated with sound light sensitivity and usually do not affect ability to function What are symptoms of a tension headache? 1. usually bilateral 2. mild to moderate pain 3. feels like a band tightening around head, making the whole head hurt 4. lasts 30 min. to several days 5. starts several hours after waking, worsens as day progresses Medications for tension headache The first line treatment is NSAIDS (including ibuprofen, aspirin, Naproxen, and Tylenol). If anxiety and depression are triggers, headaches may need treatment with antianxiety and antidepressant medications. What is a ischemic Stroke? a hypoxic state. Cellular function deficits result from impaired neurons resulting in the eventual death of brain cells. Causes of occlusion include atherosclerotic and/or arteriosclerotic changes, drugs that cause vasoconstriction (i.e., nicotine), or by a blood clot (thrombus or embolus), which blocks the circulatory pathway. What is a Hemorrhagic Stroke? Hemorrhagic stroke is typically caused by hypertension but may also be caused by other factors such as aneurysms and arteriovenous malformations. There is a weakening of the walls of blood vessels, causing eventual rupture. A cascade of events occurs following the rupture; the most significant of which is an increase in intracranial pressure and the risk of cerebral herniation. Remember that the skull is a hard, closed box which has no space for expanding size. What is aq transient ischemic attack (TIA)? a brief episode of a neurologic deficit that often comes and goes quickly. Symptoms are identical to the two major stroke types, but do not last as long, as they usually disappear in less than an hour and involve complete neurologic recovery. TIAs are typically reoccurring, and their occurrence signify an increased risk of a future cerebral infarct. Symptoms of Hemorrhagic Stroke - Sudden onset of severe headache What is Alzheimer's disease? Dementia that is characterized behaviorally by anterograde amnesia (can remember the past but cannot form new memories). Visual memory is also impaired, leading to confusion with regard to orientation. What is vascular dementia? Caused by multi-infarcts over time and includes lacunar and multiple cortical infarctions. Associated with HTN, stroke, TIA. Makes up about 15-20% of patients with chronic dementia. What is levy body dementia? Lewy-body dementia is a progressive form of dementia in which brain cells are damaged due to a buildup of a protein called alpha- synuclein. Additionally, a loss of dopamine-producing neurons and acetylcholine is evident. What are the symptoms of vascular dementia? - Abrupt onset - Fluctuating symptoms - Psychosis - Depression - Focal neurological symptoms (gait change) - Hypertension What are symptoms of levy body dementia? - Fluctuating cognition mimicking delirium - Recurrent well-formed visual hallucinations - Spontaneous features of Parkinsonism - Sleep disturbances - Tremor - Motor impairment - Postural instability - Increased sensitivity to neuroleptics What are the symptoms of Alzheimer's - Slow, insidious onset - Short-term memory loss (early) - Anxiety/depression (early) - Poor judgment (middle) - Hallucinations (middle) - Difficulty word finding (early middle) - Disorientation (middle) - Paranoia/Delusions (middle) - Incontinence (middle) - Motor rigidity (late) - Apraxia/agnosia (late) - Severe cognitive and language impairment (late) - Brain atrophy on MRI (Magnetic Resonance Imaging). Medications for Alzheimer's - Memantine (Namenda) This may be combined with a cholinesterase inhibitor for moderate-severe dementia. - Donepezil (Aricept), Rivastigmine (Exelon), and Galantamine (Razadyne) These are for mild-moderate dementia. What are mood (affective) disorders? Depression, or any mood disorder which includes depression, mania and hypomania is the result of the imbalance of dysfunction of the monoamine transmitter system. Involved neurotransmitters include serotonin, norepinephrine, and dopamine. In mania, neuroimaging has shown increased activity in the amygdala, which is associated with emotions. What are the symptoms of unipolar depression? - daily low or sad mood - fatigue - decreased interest in previously pleasurable activities - weight changes (loss or gain) - sleep changes (insomnia or hypersomnia) - agitation, feelings of guilt - feelings of worthlessness - difficulty concentrating - Suicidal thoughts Clients may report feelings of distress when separating from others What is (selective mutism? inability to speak in certain social situations What is general anxiety disorder? excessive worry What is specific phobia? fear of certain objects, locations or situations What is social anxiety? Heart racing, sweating, gastrointestinal upset in social situations What is Agoraphobia? Inability to leave home or avoidance of certain locations that cause increased worry or fear What medications mimic anxiety symptoms? - Antidepressants - Antipsychotics - Stimulants - Antihypertensive - Decongestants - Bronchodilators - Caffeine - St John's Wort - Yohimbe - Antihistamines. Illicit substances which mimic anxiety can include cocaine methamphetamine cannabis ecstasy lysergic acid diethylamide. Lab test for anxiety - Urine drug screen - TSH, T4-hyperthyroidism and hypothyroidism - CBC-anemia - Evaluate for cardiorespiratory disorders such as asthma, chronic lung diseases, arrhythmias, coronary artery disease as appropriate What is a panic attack? Sudden onset of intense panic in which multiple physical symptoms of stress occur, often with feelings that one is dying What are the symptoms of a panic attack? - palpitations - sweating - trembling/shaking - shortness of breath - sensation of smothering - Choking sensation - chest discomfort - nausea - feeling dizzy - lightheaded - numbness or tingling - fear of losing control - fear of dying - Client reports persistent worry that another panic attack will occur and/or reports behavioral changes or activity restriction in hopes of avoiding a future panic attack. Lab test for a panic disorder