1 :

Hint : ❤️Think anti-inflammatory.

Correct Answers:

  • Indomethacin
  • Colchicine


Rationale :

Indomethacin

🟣NSAIDs like indomethacin are first-line for pericarditis because they reduce inflammation and chest pain.

🟣They inhibit prostaglandin synthesis, decreasing the pericardial inflammatory response.

🟣Relief of pleuritic chest pain is one of the primary goals of treatment.

🟣NSAIDs also help prevent further pericardial effusion development.

🟣Monitoring includes GI side effects and renal function.

Colchicine

🟣Colchicine reduces recurrence of pericarditis and is often used with NSAIDs.

🟣It works by interfering with leukocyte activity and decreasing inflammatory response.

🟣Clinical guidelines recommend it for both acute and recurrent pericarditis.

🟣It improves outcomes and reduces the risk of chronic constrictive pericarditis.

🟣Side effects may include GI upset, so patient education is important.


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2 :

Hint : 🤒Viral illness link.

Correct Answers:

  • Recent flu-like illness.


Rationale :

💠Viral infections (often preceded by flu-like illnesses) are the most common cause of acute pericarditis.

💠Pathogens such as Coxsackievirus trigger the immune-inflammatory response in the pericardium.

💠Clients often report recent upper respiratory infections before the onset of pericarditis symptoms.

💠This risk factor helps distinguish pericarditis from conditions that are unrelated, like thyroid disease or lifestyle.

💠Education emphasizes reporting chest pain worsened by inspiration and relieved by sitting up/leaning forward, a hallmark feature.


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3 :

0810:

Skin warm and dry. Awake, alert. and oriented x3. Transferred to bed from chair. Sat up in chair x3 hours with legs dependent. Reports pain in legs as 4 on a scale of 0 to 10. Dilated veins noted on bilateral lower extremities. Pitting edema 2+ noted to bilateral lower extremities with noted hyperpigmentation. Pedal pulses palpable at 2+. Small ulcers noted on bilateral lower legs.

1020:

Skin warm and dry. Awake, alert, and oriented x3. Reports pain in legs as 6 on a scale of 0 to 10. Dilated veins noted on bilateral lower extremities. Pitting edema 3+ noted to bilateral lower extremities with hyperpigmentation of the skin. Pedal pulses palpable at 2+. Small ulcers noted on bilateral lower legs. Intermittent pneumatic compression pumps intact bilaterally.

Pentoxifylline 400 mg PO twice a day.

Acetaminophen 650 mg PO every 4 hr PRN pain.

0810:

Temperature 37.10°C (98.8°F)

Heart rate 86/min

Respiratory rate 14/min

Blood pressure 120/88 mm Hg

Oxygen saturation 96%

1020:

Temperature 37°C (98.6°F)

Heart rate 76/min

Respiratory rate 161min

Blood pressure 138/72 mm Hg

Oxygen saturation 95%


A nurse is assisting with planning caring for a client who has peripheral vascular disease. Which of the following interventions should the nurse include in the plan of care? (Select All that Apply.)


Answer Options

Hint : 🦵 Promote venous return.

Correct Answers:

  • Wear compression stockings.
  • Perform calf pump exercises with 20 repetitions, four times a day.
  • Wear intermittent pneumatic compression pumps while in bed.
  • Elevate legs four times per day for 30 minutes.


Rationale :

Wear compression stockings

✅Graduated compression stockings improve venous return by applying external pressure to the lower extremities.

✅They help decrease venous stasis, reduce edema, and minimize the risk of ulcer progression.

✅Consistent use during the day promotes circulatory efficiency and long-term symptom relief.

✅Stockings should be applied in the morning before ambulation, when swelling is least.

✅Teaching proper application and daily wear is essential for adherence.

Perform calf pump exercises with 20 repetitions, four times a day

✅Calf muscle exercises stimulate the “muscle pump” mechanism, enhancing venous return.

✅These exercises reduce blood pooling, improve oxygen delivery, and prevent clot formation.

✅Regular activity throughout the day maintains circulation, especially in clients with impaired mobility.

✅They serve as a safe alternative to prolonged ambulation when pain or ulcers are present.

✅This intervention also promotes client independence and self-care.

Wear intermittent pneumatic compression pumps while in bed

✅These devices provide cyclical compression to the legs, mimicking venous return during immobility.

✅They are especially useful when the client is in bed to reduce venous stasis and DVT risk.

✅The device improves hemodynamics and prevents further complications such as ulceration.

✅Consistent use is most beneficial when ambulation is limited.

✅This complements, but does not replace, the use of compression stockings.

Elevate legs four times per day for 30 minutes

✅Leg elevation above heart level promotes venous drainage, decreases edema, and relieves pain.

✅Frequent elevation helps manage venous hypertension and prevents worsening of skin changes.

✅This practice also reduces the risk of venous ulcers and supports wound healing.

✅It should be encouraged especially after periods of standing or sitting with legs dependent.

✅Patient teaching should include avoiding prolonged dependent positions without relief.


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4 :

Hint : 🧪Think “cytokine surge.”

Correct Answers:

  • “A deregulated cytokine storm causes an inflammatory response."


Rationale :

♦️SIRS arises from a dysregulated host response in which pro-inflammatory cytokines (e.g., TNF-α, IL-1, IL-6) surge and amplify systemic inflammation.

♦️This cytokine storm injures the endothelium, increases capillary permeability, and triggers vasodilation, leading to maldistribution of blood flow.

♦️The result is tissue hypoperfusion and a cascade that may evolve to multiple organ dysfunction.

♦️Coagulation pathways are also activated, promoting microthrombi and worsening organ ischemia.

♦️Recognizing the cytokine-driven pathophysiology explains why early source control, hemodynamic support, and anti-inflammatory/antimicrobial strategies are central to care.


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5 :

Hint : 🎈Balloon dilates mitral valve.

Correct Answers:

  • "A small catheter with a balloon on the end is threaded into a vessel in the groin and advanced to the heart where the balloon will be inflated, and the narrowed valve will be dilated. "


Rationale :

🔷This describes percutaneous balloon mitral valvotomy (PBMV), a standard intervention for symptomatic mitral stenosis that has not responded to medications.

🔷PBMV uses a transvenous catheter (typically via the femoral vein) with balloon inflation across the stenotic mitral valve to increase valve area and lower transmitral gradients.

🔷It is best suited to pliable, non-calcified valves without left atrial thrombus or significant mitral regurgitation, offering symptom relief and improved functional capacity.

🔷Compared with open surgery, PBMV is less invasive, shortens recovery time, and reduces perioperative risk in appropriate candidates.

🔷Clinical goals include reducing left atrial pressure, pulmonary congestion, and atrial arrhythmia burden, thereby improving quality of life.


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6 :

Hint : ⚡Unexplained exhaustion warns.

Correct Answers:

  • Profound fatigue


Rationale :

💠Unexplained, profound fatigue can be a prodromal sign of impending cardiac arrest, particularly in women and older adults with underlying cardiac disease.

💠It often reflects myocardial hypoperfusion or electrical instability, which may precede collapse, syncope, or malignant arrhythmias.

💠When fatigue clusters with dyspnea, palpitations, or chest discomfort, the risk of a serious cardiac event increases.

💠Educating clients to seek urgent evaluation for new, severe, or atypical fatigue can shorten time to defibrillation and definitive care.

💠Recognition of subtle prodromes supports earlier risk stratification and monitoring, potentially improving survival.


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7 :

Hint : 🫀Smoking + family history.

Correct Answers:

  • Family history of aneurysm
  • Smoking cigarettes


Rationale :

Family history of aneurysm:

◈A positive family history significantly increases risk for abdominal aortic aneurysm (AAA) through shared genetic and connective-tissue susceptibilities.

◈First-degree relatives have a higher prevalence and may warrant screening at earlier ages than the general population.

◈Familial clustering is linked to extracellular matrix abnormalities that weaken the aortic wall.

◈Recognizing heredity guides preventive counseling and ultrasound surveillance strategies.

◈Early identification reduces the chance of silent expansion and catastrophic rupture.

Smoking cigarettes:

◈Cigarette smoking is the strongest modifiable risk factor for AAA development, growth, and rupture.

◈Tobacco toxins drive elastin/collagen degradation, oxidative stress, and chronic inflammation within the aortic wall.

◈Continued smoking accelerates aneurysm expansion, while cessation slows growth and lowers operative risk.

◈Counseling on smoking cessation is therefore central to risk reduction and long-term outcomes.

◈Population data consistently confirm higher AAA incidence and mortality among smokers.


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8 :

Hint : 🌍Global public health issue.

Correct Answers:

  • Sudden cardiac arrest is considered a public health burden worldwide.


Rationale :

❖Sudden cardiac arrest (SCA) causes hundreds of thousands of deaths annually across the globe, with low survival to discharge, marking it as a major public health challenge.

❖The condition imposes substantial societal costs, including lost productivity and high health-system expenditures for emergency response and post-arrest care.

❖Outcomes hinge on public awareness, rapid EMS activation, bystander CPR, and access to defibrillation (AEDs).

❖Global initiatives focus on training lay rescuers, AED availability, and systems of care (post-ROSC, targeted temperature management, cath lab access).

❖Framing SCA as a public health problem drives policy, funding, and community-level interventions that improve survival.


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9 :

Hint : 🩸Bleeding = volume loss shock.

Correct Answers:

  • Hypovolemic shock


Rationale :

🔵Ongoing postoperative blood loss leading to a falling blood pressure indicates decreased intravascular volume and reduced preload.

🔵The compensatory response is tachycardia and tachypnea to maintain cardiac output and oxygen delivery.

🔵As circulating volume declines, stroke volume and mean arterial pressure drop, impairing organ perfusion.

🔵Without prompt volume resuscitation and source control, hypovolemic shock progresses to lactic acidosis and organ dysfunction.

🔵Recognition of the volume etiology guides immediate use of isotonic crystalloids, blood products as indicated, and hemorrhage control.


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10 :

Hint : ⚠️Report frequent balance loss.

Correct Answers:

  • "l need to walk slowly as I lose my balance often."


Rationale :

🟠In peripheral artery disease (PAD), frequent balance loss signals a high fall risk, an immediate safety concern that warrants provider notification.

🟠Ischemic limb pain, weakness, or sensory deficits can compromise gait stability and increase injury risk.

🟠Early intervention (e.g., assistive devices, physical therapy, home safety modifications) reduces falls and related morbidity.

🟠Addressing balance issues supports adherence to supervised walking programs, which are cornerstone therapies for PAD.

🟠Reporting this symptom enables targeted evaluation for neurologic or vestibular factors and optimization of PAD management.


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Total Questions: 10

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