Galen NUR 242 Exam 4 - Cardiovascular With 100% correct answers 2025-2026 already graded A+

What is the equation for cardiac output?

CO = HR x SV

What is preload?

the heart is being stretched out

What does preload reflect?

how much fluid is in the heart

What is afterload?

resistance the ventricle must overcome to eject blood

Example of increased preload

CHF

Example of increased afterload

hypertension

What is blood pressure?

force of blood against vessel walls

What is systolic blood pressure?

amount of pressure generated by the left ventricle to distribute blood into the aorta with each CONTRACTION of the heart

What is diastolic blood pressure?

amount of pressure against the arterial walls during RELAXATION of the heart

What is the equation for MAP?

2(diastolic) + systolic / 3

What is the minimum the MAP can be to maintain adequate perfusion?

no less than 60

What is another name for orthostatic changes?

postural hypotension

A decrease of more than 20 mmHg systolic or more than 10 mmHg diastolic pressure with an increase in heart rate

orthostatic change

How do you measure orthostatic changes?

Check blood pressure in the following order: after laying supine for 3 minutes, after sitting for 1 minute and standing *Keep cuff in same place*

What precautions are important for a patient experiencing orthostatic changes?

fall

Who is at risk for orthostatic changes?

prolonged bed rest, medications, dehydration, volume depletion, autonomic nervous system disorders

Cardiovascular assessment

general apperance, skin, weight, edema, extremities, blood pressure

Markers of myocardial damage

troponin, creatinine kinase, CKMB, myoglobin, serum lipids, homocystine levels

Normal lipid levels

Total cholesterol <200mg/dL, LDL (Cardiac pt) <70/dL, LDL (Non-Cardiac pt) <130/, HDL >40mg/dL, Triglycerides <150mg/dL

Cardiac Diagnostic Tests

ECG, Echocardiogram, Cardiac Catherization

Nursing considerations for cardiac catherization

informed consent, patent IV, allergies to iodine or shellfish, NPO, height, weight, sensations from dye, post procedure care (bed rest 6 hours, leg straight, assess vitals and pulse frequently)

What is a normal ejection fraction?

55-65%

What are the contraindications for cardiac catherization?

due to use of dye - renal failure/insufficiency (cret >1.5) or metformin use in the last 48 hours

Why is a cardiac catherization conducted?

blockage in coronary arteries

All rythm issues are ____________ related

electrical/conduction

P Wave

atrial contraction / atrial depolarization

QRS complex

ventricular contraction / ventricular depolarization

T Wave

ventricular relaxation/ ventricular repolarization

In order for a ryhtm to be sinus it must have:

orginating from the sinus node with a normal P, QRS and T segment AND be between 60-100 bpm

Sinus bradycardia

originating from the sinus node, normal segments but slower ; rate less than 60 bpm

Symptomatic bradycardia

dizzy, faint, lightheaded, diophoretic, hypotensive

Emergency treatment of bradycardia

atropine 0.5 - 1mg IV

Sinus tachycardia

originates from sinus node, contains all the segments but is fast; rate > 100bpm

Causes of tachycardia

fever, pain, dehydration, hyperthyroid, anxiety, energy drinks, medications, illicit drugs

What is the most common arrythmia?

atrial fibrillation (Afib)

What are the unique characteristics of Afib?

no P wave, wavy baseline

Uncoordinated electrical activity of the atria with no good contraction that causes atrial quivering

Afib

Patient reports feeling of heart beating rapidly, flutter in the chest

Afib

What are the treatment priorities for Afib?

#1 - rate control #2 - anticoagulation

What medications are used for rate control in Afib?

beta blockers, verapamil, diltiazem, digoxin, amiodarone

Risk factors for Afib

heart failure, hypertension, obesity, CAD, ETOH abuse, COPD, sleep apnea

The patient with Afib is at high risk for ______

stroke

Patient with Afib is prone to

CHF

Patient centered collaborative care

drug therapy, cardioversion with TEE, implantable pacemaker, maze procedure, percutaneous radiofrequency catheter ablation

What is the purpose of a transesophageal echo(TEE)?

look for a clot to determine if patient can be cardioverted

What is defibrilation?

treatment for immeidate life threatening arrythmia when patient is pulseless (Vfib or Pulseless Vtach ONLY)

What is cardioversion?

synchronus countershock that depolarizes critical mass of myocardium to allow sinus node to regain control

Premature complexes

ventricular beat that comes early and wide

Reasons for premature complex dysryhtmias

weak heart, too much stimulant, electrolyte imbalance

Ventricular tachycardia

repetitive firing of irritable ventricular ectopic focus ; rate of 140-180 bpm

What can ventricular tachycardia lead to?

Ventricular fibriliation

ventricular fibrillation

result of electrical chaos in ventricles; medical emergency as patient is always pulseless

Ventricular Asystole

complete absence of any ventricular rhythm

Care of ventricular asystole

CPR x 2 minutes, Epi q 3-5 min

drop of blood through the heart

Vena cava, right atrium, right ventricle, pulmonary arteries, pulmonary veins, left atrium, left ventricle, aorta.

VHD

valvular heart disease

ETOH abuse can lead to

dilated cardiomyopathy

congestive heart failure

CHF

Heart is unable to pump enough blood with each beat to meet the oxygen demands of heart and other body tissues

Congestive Heart Failure (CHF)

How many people are living with CHF?

6.6 million in the US; 23 million worldwide

Etiology of CHF

CAD, Ischemic MI, HTN, VHD, myocarditis, substance abuse, peripartum cardiomyopathy

Pathophysiology of heart failure

insult to the heart (MI, viral infection, etc) causes weakening of hear muscle that leads to decreased contractility and decreased cardiac output

Features of heart failure related to volume overload

dyspnea on exertion, edema, orthopnea, paroxysmal nocturnal dyspnea, hepatic congestion, crackles in lungs

Features of heart failure realted to low output

fatigue, dizziness, decreased mentation, weak pulses, cool extremities

5 areas to listen to the heart

aortic, pulmonic, erb's point, tricuspid, mitral

Left sided heart failure

paroxysmal nocturnal dyspnea, elevated pulmonary capillary wedge pressure, pulmonary congestion (cough, crackles, wheezes, blood-tinged sputum, tachypnea), restlessness, confusion, orthopnea, tachycardia, exertional dyspnea, fatigue, cyanosis

Right sided heart failture

fatigue, increased peripheral venouse pressure, ascites, enlarged liver & spleen, secondary to chronic pulmonary problems, distended jugular veins, anorexia, complaints of GI distress, weigh gain, dependent edema

Diagnostic testing for heart failure

echocardiogram, CXR, EKG, cardiac enzymes, CMP, BNP

Why is the echocardiogram the best test for heart failure?

reveals the structures of the heart, the heart function, and the ejection fraction

What ejection fraction is considered failure?

<40%

Drug therapy for CHF

loop diuretics, ACE, ARB, Beta Blocker, spirnolactone, digoxin

What do diuretics do for CHF?

decrease preload

What do ACE and ARBs do for CHF?

decrease preload and afterload

What do beta blockers do for CHF?>

decrease afterload

What is the impact of digoxin when used for CHF?

positive inotropic and negative chronotropic

What does inotropic mean?

contractility

What does chronotropic mean?

heart rate

What medication class is contraindicated in CHF?

calcium channel blockers

What is first line treatment for CHF?

diuretic + ACE or ARB + beta blocker

What are the end stage interventions for CHF?

BiV pacing, A1CD, Transplant, LVAD, Hospice

What non-surgical options are there for heart failure?

CPAP, biventricular pacing

What surgical options are there for heart failure?

heart transplant, ventricular assist device

Interventions for heart failure

improve gas exchange, I&O, daily weights, low sodium diet, fluid restrictions, medication compliance, smoking cessation, patient education on drug regimen and side effects

Discharge instructions for patient with CHF

Immediately report: weight gain, decrease in exercise tolerance, cold symptoms, excessive nocturia, dyspnea at rest, angina, increaed swelling

Emergency complication of heart failure

flash pulmonary edema: tachypnea, dyspnea, wheeze, crackles, wet cough, diaphoresis, anxiety, profound accessory muscle breathing and pink tinged sputum

Flash pulmonary edema interventions

remain with client, notify the provider, high folwer's position, supplemental oxygen, anticipate orders for loop diuretic, nitrates, and morphine, I&O, insert foley

Desired blood pressure for people over 60

below 150/90

Desired blood pressure for people under 60

below 140/90

Essential hypertension risk factors

obesity, smoking, race (African American), excessive and continuous stress, family history, hyperlipidemia, physical inactivity

Secondary hypertension risk factors

kidney disease, pregnancy, primary aldosteronism, Cushing's syndrome, medications

Clinical manifestations of hypertension

Asymptomatic-Headache,Flushed face

dizziness

Questions to ask when assessing someone with hypertension

family history, dietary intake, occupation, BMI, exercise habits

Diagnostic assessments for hypertension

ECG, kidney function testing, UA

Lifestyle changes important for patient with hypertension

exercise, weight reduction, DASH diet (reduced caffiene, sodium, alcohol, lipids), smoking cessation, stress management

Ongoing management of hypertension

blood pressure diary, vision testing, and surveillance kidney disease

Medications used to treat hypertension

diuretics, angiotensin converting enzyme inhibitors, angiotension receptor blockers, calcium channel blockers, renin inhibitors, central alpha agonists and beta blockers

Hypertensive crisis

severe headache, extremely high blood pressure, dizziness, blurred vision, short of breath, epistaxis, chest pain

Interventions of hypertensive crisis

semi fowlers, calm envirpnment, critical care admission, monitor blood pressure q 15-30 minutes

Treatment of hypertensive crisis

IV nicardipine, IV nitroglycerin; as needed IV labetalol

arteriosclerosis

artery walls become thicker, harder and less elastic