Test 3 NUR 145 Questions and 100%
Correct Answers
Atherosclerosis ✅The abnormal accumulation of lipid deposits and fibrous tissue within
the arterial walls and lumen, referred to as plaque or atheromas; CAD is the most
prevalent and the leading cause of death in the US; CAD usually begins with HTN
Plaque ✅The buildup of deposits in the arteries r/t CAD; This causes blockages which
reduce blood flow; The area of the artery affected cannot dilate because the wall is less
elastic, which increases the risk of spasm, embolism, and thrombosis; When the vessel
is about 65 - 75% occluded, symptoms begin as angina
Symptoms of CAD ✅Caused by myocardial ischemia, which manifests as angina in
the general area (back pain, leg pain, etc., usually left side); Other symptoms include
epigastric distress, pain that radiates to the jaw or left arm, SOB, and eventually leading
to MI, heart failure, and even sudden cardiac death
Risk Factors for CAD ✅Cholesterol abnormalities (LDL, triglycerides), tobacco use,
HTN, DM, stress response, pregnancy, post-menopause, birth control pills (with tobacco
use) and metabolic syndrome (risk depends on your amount of adipose tissue); C-
reactive proteins (CPR) and homocystine levels that are elevated are also a risk factor
for heart disease
Cholesterol Medications ✅HMG-CoA (statins), Niacin, fibrates, resins, cholesterol
absorption inhibitors, and omega-3 acid-ethyl esters; These medications lower
cholesterol (high cholesterol means you have too many "building blocks" for plaque
formation; HDL, which contributes to dropping LDL (plaque forming cholesterol) levels,
should have a high prevalence in the body
Stable Angina ✅Most common; Should only last about 5 - 15 minutes; Occurs with
over exertion and is relieved by rest and nitro
Unstable Angina ✅Increased intensity, duration, and frequency; Nitro and rest typically
does not relieve this; Requires medical intervention
Prinzmetals (Variant) Angina ✅Angina related to the spasm of a coronary artery
Silent Ischemia ✅Often in pts. with DM r/t diabetic nephropathy; No symptoms occur
but ECG changes can be seen
Angina in Geriatric Pts. ✅Usually, angina in geriatric pts. is interpreted as weakness
and fatigue; Teach older adults to recognize "chest pain-like" symptoms; Lower doses
are needed for older pts. due to toxicity considerations
,Medical Management of Angina ✅The goal is to decrease O2 demand or increase O2
supply; Nitrates, beta blockers, CCBs, and antiplatelet drugs decrease the O2 demand;
If the angina is severe, stents, angioplasty, or CABG may be needed
Myocardial Infarction ✅Aka Acute Coronary Syndrome (ACS), coronary occlusion, or
heart attack; Usually occurs in the morning after wakening; Can occur when a plaque
ruptures, causing inflammation and platelet aggregation (80 - 90% of cases);
Characterized by an acute onset of myocardial ischemia that results in myocardial death
if interventions do not occur promptly; Characterized by non-ST elevation MI and ST
elevation MI; 20 minutes until cell death, 4-6 hours for entire heart muscle depth death
Non-STEMI MI ✅Aka subendocardial; A partial occlusion MI; Determined by ST
segment depression (J point) and elevated troponin (heart cell protein), creatine kinase
(CK), myoglobin, and cardiac marker (released when a heart cell dies) levels
STEMI MI ✅Aka transmural; A complete occlusion; Determined by an elevated ST
segment and elevated troponin/myoglobin/CK/cardiac marker levels
MI S/S ✅Chest pain that occurs suddenly without explanation, radiates to the
shoulder, jaw, epigastric area, etc. and continues despite intervention, SOB, C/O
indigestion, nausea, anxiety, cool pale skin, and increased HR and R; Picture an MI like
a target - there is a central zone of necrosis, a zone around it of injured, but NOT
DEAD, non-conducting/contracting muscle, and a zone on the outside of ischemic
muscle; The goal is to PRESERVE the cells that are alive (MONA)
Pericardial Effusion ✅The accumulation of fluid in the pericardium; Can cause SOB,
angina, chest "fullness", lightheadedness, etc.; Leads to cardiac tamponade
Cardiac Tamponade ✅Occurs with pericardial effusion; This puts pressure around the
heart and it cannot fill or pump effectively, resulting in a dangerously low BP; This is a
medical emergency and the fluid must be drained
Coronary Artery Stent ✅A woven mesh that provides structural support in a coronary
artery; It is placed through cardiac catheterization; This is done due to blockage of an
artery r/t plaque buildup or thrombus formation
Coronary Artery Bypass Graft (CABG) ✅A surgical technique to bring a new blood
supply to heart muscle by detouring around blocked arteries when a cardiac stent
cannot be placed
MONA ✅Morphine, Oxygen, Nitro, and Aspirin; This combination preserves the heart
for some time during an MI
, Pericarditis ✅Sudden inflammation of the pericardium caused by a viral infection or MI;
Manifests as sharp, stabbing chest pain that may travel to the left shoulder or neck;
Usually doesn't last long and resolves on its own
Cardiogenic Shock ✅Caused by decreased CO -> inadequate tissue perfusion ->
shock; Commonly occurs following acute MI when a large area of the myocardium
becomes ischemic and hypokinetic; The brain and other vital organs cannot get enough
O2; It is very difficult to pull someone out of CS and it will often kill the pt.
Heart Failure (HF) ✅A chronic and often progressive condition that impairs the ability
of the ventricle to fill or eject blood; This inability means the heart is unable to pump
enough blood to meet the body's metabolic demands or needs; Can be a systolic
dysfunction (pumping) or diastolic dysfunction (filling) and may cause pulmonary or
systemic congestion
Right-Sided HF ✅Only 1/3 of cases; Due to left-sided HF and causes pulmonary
disease or pulmonary HTN due to backup of blood
Risk Factors of HF ✅Advanced age, CAD, DM, smoking, obesity, cholesterol levels,
HTN (75% of cases), sleep apnea, anemia, alcohol abuse, ethnicity (African American)
Left Sided Systolic HF ✅The EF is <40%; The left ventricle doesn't fully empty
because of poor contractility, which results in decreased CO
Left Sided Diastolic HF ✅The EF is normal or high (50 - 70%), but the left ventricle
does not fill properly due to dysrhythmias, a stiff ventricle, and/or a short diastolic
periods; This lowers preload, thus lowering CO
Pathophysiology of HF ✅Decreased CO and increased left ventricular end diastolic
volume (LVEDV) because LV cannot fully empty; Blood pools in LV and LVEDV
increased causing LV to stretch and enlarge, further decreasing the contractility and SV;
Body tries to compensate, but makes the condition worse
Right-Sided HF S/S ✅SWELLING; Swelling of the legs, wt. gain, edema (dependent,
pitting), large neck veins (JVD), lethargy, irregular HR, nocturia, and girth (enlargement)
of the abdomen and liver
Left-Sided HF S/S ✅DROWNING; Dyspnea, rales (crackles) in lungs,
orthopnea/oliguria, weakness, nocturnal dyspnea (PND), increased R (low O2) and HR,
nagging cough, and wt. gain; Sometimes, an S3 sound is heard on auscultation and is
known as "The HF Sound;" It's caused by blood already pooling in the ventricle and
more blood rushing in
