Nu 372 Final Exam (Answered)
2025/2026. 118 Questions and Correct
Answers.
Angina
-chest pain brought about by myocardial ischemia
Manifestations:
-Chest Pain: substernal, precordial, may radiate to neck/arms/shoulders or jaw
-Usually lasts 2-5 minutes
-Quality: tight, squeezing, constricting, heavy sensation, burning, dull, aching, constant
-Dyspnea, pallor, tachycardia, anxiety and fear, indigestion, nausea, vomiting, upper back pain
-ECG changes: T-wave inversion and depressed ST segments (inverted T-wave = myocardial
ischemia)
Treatment:
-Nitroglycerin: goal is to reduce oxygen demand and increased oxygen supply to the myocardium
-Organic nitrates: short and long-term forms, used to treat acute angina attacks and prevent angina
Nursing interventions:
-know when the angina is happening
-decrease demands of O2 needed on the heart
-increase effectiveness of medication
-reduce anxiety
-patient should stop all activity and sit and rest in bed (semi-fowler position)
-administer oxygen 2 L/min through nasal cannula
-assess patients pain, vital signs, RR
-Tell patient to carry nitroglycerin at all times
Stable angina
-Most common type
-Chest pain that occurs when a person is active or under severe stress (cold, etc.)
-Usually subsides with rest
-Treatment: nitrates, reducing stress/activity
Clinical Manifestations: angina that usually occurs when work of the heart increased by physical
exertion: physical activity, emotion, stress, eating a heavy meal, exposure to cold
Unstable angina
-Angina that is not relieved with rest
-Requires medical intervention
-Occurs with increased frequency, severity, and duration
-Pain occurs with decreasing level of activity or stress
-May occur when the patient is just resting
,-Patient is at risk for myocardial infarction (MI)
Clinical manifestations:
-chest pains during periods of rest or very little activity
Nitroglycerin
Short acting sublingual Nitroglycerin:
-Drug of choice for treating acute angina
-Takes effect in 1-2 minutes
-Decreases myocardial workload and oxygen demand
-Make sure no lesions/abrasions under the tongue that could effect absorption
-Do not swallow: could cause medicine to lose its effectiveness if it enters the stomach
-1 sublingual tablet dissolved under the tongue or in the buccal pouch as soon as angina
begins. Repeat every 5 minutes, if needed, to a maximum of three doses within a 15-minute period.
Client must call for medical assistance if angina is not relieved after third dose
Longer acting Nitroglycerin prep:
-comes in an oral tablet, ointment, or transdermal patches
-used to prevent angina attacks—NOT to treat acute attacks
-main problem is development of tolerance
-nitrate free periods can limit tolerance by scheduling with a period of 8-10 hrs per day
-scheduled to give at night when patient is less likely to experience angina
Transbuccal administration:
-Check the inside of the patients cheek to make sure there are no ulcerations or abrasions that
could interfere with the absorption of the drug
-Have the patient place between gums and cheek until full absorbed
-Do not swallow
-Rotate from side to side with each dose
Transdermal administration:
-discuss the administration with the patient
-make sure the patient knows to take off old transdermal patches and wash the area before
replacing a new one to prevent severe hypotension
-inform patients that they should label in big writing their tubes to prevent someone (or
themselves) from using it as hand lotion which would cause drug toxicity
Headache is common side effect for both long and short acting nitrates
Cardiomyopathy
-a disease that affects the heart muscle and its ability to pump effectively
-Heart is enlarged and the walls become thick and rigid
Complications: Heart becomes weaker and has a hard time pumping blood leading to heart failure
and dysrhythmias
Causes:
,-Acquired: develops from another disease
-Inherited: results from genetic conditions passed from parent to the child
-Idiopathic: unknown why it happens
Diagnostic tests:
-Echocardiography: to measure the ejection fraction
-Chest X-ray: to see enlargement of heart
-Cardiac catheterization: to view inside the heart
Management:
Pharmacological therapy:
-Ace inhibitors, calcium channel blockers, beta blockers, Digoxin (slow the HR down)
-Digoxin: monitor for hyper-contractile pump
Surgical options:
-Heart transplant: is the only cure for dilated cardiomyopathy (DCM)
-Left ventricular assistive devices (LVads): these can increase the patients cardiac output while they
wait for a heart donor; it's an electrical pump surgically implanted in the abdominal cavity; aid in
perfusion; patient needs to be hooked up to a power source the entire time
-Pacemakers or ICDs (implantable cardioverter defibrillator)
Dilated Cardiomyopathy (DCM)
-Most common
-Ventricular enlargement
-Reduced ejection fraction (EF) due to diastolic and systolic volumes increasing
-Risk Factors: Men, genetics
-S/S: dyspnea, fatigue, weakness, edema, S3 & S4 (you'll hear both), dysrhythmias
-Overtime causes heart failure because the muscle becomes weaker
-Clinical manifestations: shortness of breath, fatigue, and swelling of the lower extremities, JVD
-Happens gradually, some patients are asymptomatic
Hypertrophic Cardiomyopathy (HCM)
-Decreased appliance of the left ventricle and hypertrophy of the ventricular muscle mass
-Heart muscle becomes really thick—which decreases hearts ability to pump effectively
-Impaired ventricular filling because the ventricle is smaller due to how thick the heart is
-S/S: dyspnea, fatigue, weakness, syncope (loss of consciousness), dizziness, S4, dysrhythmias
-a cardinal symptom of HCM is a harsh systolic injection murmur
-Clinical manifestations: patient will have angina, chest pain, ischemia, may have AFIB
-Symptoms are going to develop when they are doing physical activity because oxygen demand is
increased
Coronary Artery Disease (CAD)
, -Most common type of heart disease
-Number 1 cause of death in men and women
-caused by impaired blood flow to the myocardium and is usually due to atherosclerotic plaque in
the coronary arteries
-Coronary atherosclerosis most common cause of reduced coronary blood flow
Risk factors:
-Elevated LDL "bad cholesterol"
-Metabolic syndrome (cluster condition that increases risk for heart disease, stroke, diabetes)
-Eventually causes temporary/reversible myocardial ischemia
Clinical manifestations:
-Usually asymptomatic
-Most common manifestations are angina pectoris and myocardial infarction (MI)
Complications:
-Angina pectoris (ischemia)
-Acute coronary syndrome
-Myocardial infarction
-Dysrhythmias
-Heart failure
-Sudden cardiac death
Labs:
-Cholesterol levels (HDL, LDL)
-Glucose levels
-Blood lipids and lipid protein levels
Education for Patient:
-Diet: high in fruits, vegetables, whole grains and unsaturated fatty acids
-Exercise: at least for 30 minutes a day
-BMI: less than 30, anything above is obesity, look at fat distribution
-Smoking cessation
-Controlling HTN
-Controlling diabetes
-Controlling their hyperlipidemia (LDL and HDL levels)
Medications:
-3-hydroxy-3-methylglutaryl coenzyme A (STATINs)
-Nicotinic acids
-Fibric acids (fibrates)
-Bile acid sequestrants (resins)
-Cholesterol absorption inhibitors
-Omega-3 acid ethyl esters
Cholesterol/Lipid lab values
2025/2026. 118 Questions and Correct
Answers.
Angina
-chest pain brought about by myocardial ischemia
Manifestations:
-Chest Pain: substernal, precordial, may radiate to neck/arms/shoulders or jaw
-Usually lasts 2-5 minutes
-Quality: tight, squeezing, constricting, heavy sensation, burning, dull, aching, constant
-Dyspnea, pallor, tachycardia, anxiety and fear, indigestion, nausea, vomiting, upper back pain
-ECG changes: T-wave inversion and depressed ST segments (inverted T-wave = myocardial
ischemia)
Treatment:
-Nitroglycerin: goal is to reduce oxygen demand and increased oxygen supply to the myocardium
-Organic nitrates: short and long-term forms, used to treat acute angina attacks and prevent angina
Nursing interventions:
-know when the angina is happening
-decrease demands of O2 needed on the heart
-increase effectiveness of medication
-reduce anxiety
-patient should stop all activity and sit and rest in bed (semi-fowler position)
-administer oxygen 2 L/min through nasal cannula
-assess patients pain, vital signs, RR
-Tell patient to carry nitroglycerin at all times
Stable angina
-Most common type
-Chest pain that occurs when a person is active or under severe stress (cold, etc.)
-Usually subsides with rest
-Treatment: nitrates, reducing stress/activity
Clinical Manifestations: angina that usually occurs when work of the heart increased by physical
exertion: physical activity, emotion, stress, eating a heavy meal, exposure to cold
Unstable angina
-Angina that is not relieved with rest
-Requires medical intervention
-Occurs with increased frequency, severity, and duration
-Pain occurs with decreasing level of activity or stress
-May occur when the patient is just resting
,-Patient is at risk for myocardial infarction (MI)
Clinical manifestations:
-chest pains during periods of rest or very little activity
Nitroglycerin
Short acting sublingual Nitroglycerin:
-Drug of choice for treating acute angina
-Takes effect in 1-2 minutes
-Decreases myocardial workload and oxygen demand
-Make sure no lesions/abrasions under the tongue that could effect absorption
-Do not swallow: could cause medicine to lose its effectiveness if it enters the stomach
-1 sublingual tablet dissolved under the tongue or in the buccal pouch as soon as angina
begins. Repeat every 5 minutes, if needed, to a maximum of three doses within a 15-minute period.
Client must call for medical assistance if angina is not relieved after third dose
Longer acting Nitroglycerin prep:
-comes in an oral tablet, ointment, or transdermal patches
-used to prevent angina attacks—NOT to treat acute attacks
-main problem is development of tolerance
-nitrate free periods can limit tolerance by scheduling with a period of 8-10 hrs per day
-scheduled to give at night when patient is less likely to experience angina
Transbuccal administration:
-Check the inside of the patients cheek to make sure there are no ulcerations or abrasions that
could interfere with the absorption of the drug
-Have the patient place between gums and cheek until full absorbed
-Do not swallow
-Rotate from side to side with each dose
Transdermal administration:
-discuss the administration with the patient
-make sure the patient knows to take off old transdermal patches and wash the area before
replacing a new one to prevent severe hypotension
-inform patients that they should label in big writing their tubes to prevent someone (or
themselves) from using it as hand lotion which would cause drug toxicity
Headache is common side effect for both long and short acting nitrates
Cardiomyopathy
-a disease that affects the heart muscle and its ability to pump effectively
-Heart is enlarged and the walls become thick and rigid
Complications: Heart becomes weaker and has a hard time pumping blood leading to heart failure
and dysrhythmias
Causes:
,-Acquired: develops from another disease
-Inherited: results from genetic conditions passed from parent to the child
-Idiopathic: unknown why it happens
Diagnostic tests:
-Echocardiography: to measure the ejection fraction
-Chest X-ray: to see enlargement of heart
-Cardiac catheterization: to view inside the heart
Management:
Pharmacological therapy:
-Ace inhibitors, calcium channel blockers, beta blockers, Digoxin (slow the HR down)
-Digoxin: monitor for hyper-contractile pump
Surgical options:
-Heart transplant: is the only cure for dilated cardiomyopathy (DCM)
-Left ventricular assistive devices (LVads): these can increase the patients cardiac output while they
wait for a heart donor; it's an electrical pump surgically implanted in the abdominal cavity; aid in
perfusion; patient needs to be hooked up to a power source the entire time
-Pacemakers or ICDs (implantable cardioverter defibrillator)
Dilated Cardiomyopathy (DCM)
-Most common
-Ventricular enlargement
-Reduced ejection fraction (EF) due to diastolic and systolic volumes increasing
-Risk Factors: Men, genetics
-S/S: dyspnea, fatigue, weakness, edema, S3 & S4 (you'll hear both), dysrhythmias
-Overtime causes heart failure because the muscle becomes weaker
-Clinical manifestations: shortness of breath, fatigue, and swelling of the lower extremities, JVD
-Happens gradually, some patients are asymptomatic
Hypertrophic Cardiomyopathy (HCM)
-Decreased appliance of the left ventricle and hypertrophy of the ventricular muscle mass
-Heart muscle becomes really thick—which decreases hearts ability to pump effectively
-Impaired ventricular filling because the ventricle is smaller due to how thick the heart is
-S/S: dyspnea, fatigue, weakness, syncope (loss of consciousness), dizziness, S4, dysrhythmias
-a cardinal symptom of HCM is a harsh systolic injection murmur
-Clinical manifestations: patient will have angina, chest pain, ischemia, may have AFIB
-Symptoms are going to develop when they are doing physical activity because oxygen demand is
increased
Coronary Artery Disease (CAD)
, -Most common type of heart disease
-Number 1 cause of death in men and women
-caused by impaired blood flow to the myocardium and is usually due to atherosclerotic plaque in
the coronary arteries
-Coronary atherosclerosis most common cause of reduced coronary blood flow
Risk factors:
-Elevated LDL "bad cholesterol"
-Metabolic syndrome (cluster condition that increases risk for heart disease, stroke, diabetes)
-Eventually causes temporary/reversible myocardial ischemia
Clinical manifestations:
-Usually asymptomatic
-Most common manifestations are angina pectoris and myocardial infarction (MI)
Complications:
-Angina pectoris (ischemia)
-Acute coronary syndrome
-Myocardial infarction
-Dysrhythmias
-Heart failure
-Sudden cardiac death
Labs:
-Cholesterol levels (HDL, LDL)
-Glucose levels
-Blood lipids and lipid protein levels
Education for Patient:
-Diet: high in fruits, vegetables, whole grains and unsaturated fatty acids
-Exercise: at least for 30 minutes a day
-BMI: less than 30, anything above is obesity, look at fat distribution
-Smoking cessation
-Controlling HTN
-Controlling diabetes
-Controlling their hyperlipidemia (LDL and HDL levels)
Medications:
-3-hydroxy-3-methylglutaryl coenzyme A (STATINs)
-Nicotinic acids
-Fibric acids (fibrates)
-Bile acid sequestrants (resins)
-Cholesterol absorption inhibitors
-Omega-3 acid ethyl esters
Cholesterol/Lipid lab values
