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IT1 Exam 2 - Part 2

Total questions: 103

Worksheet time: 1hrs 5mins

Name
Class
Date
1.

What is the 1st sign of digoxin toxicity?

a)

GI upset: nausea, vomiting, diarrhea

b)

Neuro: confusion, dizziness, headache

c)

Visual disturbances

d)

Hyperkalemia

2.

Who should take precaution when taking digoxin?

a)

Acute MI

b)

Electrolyte imbalances/renal sufficiency

c)

Sinus node block

d)

Hypothyroidism

e)

Hyperthyroidism

3.

What are some monitoring parameters for Digoxin?

a)

Potassium

b)

GI effect

c)

Renal function

d)

HR

e)

EKG

4.

What is Ivabradine?

a)

New agent

b)

reduces HR by selective inhibition of funny current

c)

Similar to digoxin (in a sense)

d)

Normalizes HR

e)

Control HR

5.

What are some adverse effects of Digoxin?

a)

Bradycardia

b)

Hypotension

c)

Atrial fibrillation

d)

Phosephene ring/spot

e)

Dizziness

6.

What are some contraindications of Digoxin?

a)

Acute decompensated HF

b)

Pacemaker dependence

c)

Concomitant use of CYP3A4 inhibitors

d)

Reduced CO

e)

Inability to exercise

f)

P

7.

If a patient is hypoperfused and their HR is <70 what should they be put on?

a)

Digoxin

b)

Ivabradine

c)

Isosorbide

8.

IF a patient is hypoperfused and HR >70 what medication should they be put on for symptom resolution?

a)

Digoxin

b)

Ivabradine

c)

Isosorbide

d)

Hydralazine

9.

What are some characteristics of Stage D?

a)

Pts experience persistent and severe symptoms despite optimal therapy

b)

Fluid retention

c)

Severe impairment of functional exercise

d)

History of >1 HF hospitalization in last 6 months

e)

Memory loss

10.

Select all that apply: Why shouldn't you put patient on BB?

a)

Bradycardia

b)

Fluid overload

c)

Low BP

11.

Reasons you shouldn't put pt on ACEi?

a)

Hypotension

b)

High potassium

c)

Acute renal failure

d)

Ejection fraction

12.

What do you do it pt can't be put on ACEi bc high potassium and acute renal function BUT you can put them on BB?

a)

Hydralazine Isosorbide

b)

Digoxin

c)

Telmisartan

d)

Bisoprolol

e)

Milronone

13.

What can you tell from the info: SCr=3 (Baseline =1)

a)

Abrupt change in SCr

b)

Acute condition

c)

Condronic condition

d)

Reduced ejection fraction

e)

CAD

14.

What is true about Preserved Ejection Fraction?

a)

Not fully filling

b)

Not fully contracting

c)

Looks like HF in ECHO

d)

Ejection Fraction looks normal 

e)

Look like HF in EKG

15.

What is a risk factor for HFpEF?

a)

HTN

b)

Age

c)

Female

d)

Atrial fibrillation

e)

Male

16.

What are the goals for HFpEF?

a)

Increase diastolic filling time

b)

Increase contractions

17.

Which is kinda more recommeded for HFpEF?

a)

ARBS

b)

ACEi

c)

BB

d)

CCB

18.

What should we use for patient with HFpEF?

a)

ANY BB

b)

ANY ACE/ARB

c)

ARNI

d)

NITRATES

e)

DIGOXIN

19.

Which heart condition has strict rules on which BB to use?

a)

HFrEF

b)

HFpEF

20.

What to avoid in HFpEF?

a)

Digoxin

b)

Hydralazine

c)

ARNI

d)

ARBS

e)

ACE

21.

HF patient, all symptoms, ECHO, EF=70%, which of the following could you use: select all that apply:

a)

Metoprolol Succinate

b)

Metoprolol Tartrate

c)

Bisoprolol

d)

Atenolol

e)

All of the above

22.

HF patient, all symptoms, ECHO, EF=20%, which of the following could you use: select all that apply:

a)

Bisoprolol

b)

Carvedilol

c)

Metoprolol Succinate

d)

Atenolol

e)

Metoprolol Tarrate

23.

What are some causes for acute decompensated HF?

a)

Medication non-adherence

b)

Too much salt

c)

Direct heart damage

d)

Cardiac events

e)

Hemodynamics

24.

What would categorized a person to being a acute decompensated HF patient?

a)

Stage D (ACC/AHA)

b)

Class III-IV (NYHA)

c)

Dry

d)

Wet

e)

Cold

25.

Why is a 12 lead ECG helpful?

a)

To look for arrhythmia

b)

Took look for STEMI

c)

EF

d)

Edema

26.

What is released when you have MI?

a)

Troponin

b)

Nitric Oxide

c)

Enzymes

d)

K

e)

Na

27.

What are examples of noninvasive monitoring?

a)

ECG

b)

automatic BP pressure

c)

Pulse oximetry

d)

Urine flow monitoring

e)

Pulmonary artery catheter

28.

Which describes central venous lines?

a)

tells you how much fluid is in veins

b)

DIRECTLY measures BP in the arteries

c)

measures volume of blood by the heart

29.

Why would you need to use a arterial line?

a)

Measures arterial pressure DIRECTLY measures BP in the arteries

b)

blood drains from appendages -> stay in core (where vital organs are)

c)

Gives medications directly bc they could irritate veins

d)

measures how much oxygen is in the veins

30.

Which describes Subset I?

a)

Warm

b)

Dry

c)

Wet

d)

Cold

31.

Which describes Subset II?

a)

Wet 

b)

Warm

c)

Cold

d)

Dry

32.

Patient: perfusion OK, BP OK, No blue lips but congested and fluid overloaded what subset are they?

a)

Subset I

b)

Subset II

c)

Subset III

d)

Subset IIII

33.

What should be prescribed to someone in subset II?

a)

IV loop diuretics

b)

Beta blocker

c)

ARB

d)

ACEi

34.

What if patient in Subset II does not get improvement from IV loop diuretics? What can we do?

a)

Continuous IV diuretics

b)

Dialysis

c)

Combination therapy of thiazide, thiazide like and K sparing

d)

ACEi/ARB

35.

Which describes subset III?

a)

Cold

b)

Dry

c)

Wet

d)

Warm

36.

What are Inotropes used for?

a)

Patients that have low output status

b)

Patients that can't pump

c)

Patients that have problems with filling

37.

What are some things that come along with using Inotropes?

a)

Causes heart to work harder

b)

Makes heart attacks worse

c)

Increase mortality with use

d)

Increase risk of arrhythmia

e)

Lowers BP

38.

True or false: Inotropes help manage HF symptoms

a)

False

b)

True

39.

What is the true about Inotropes?

a)

Opposite of beta blocker

b)

Milrinone increases contractility and works on same receptor as Dobutamine

c)

Digoxin is strong and comparable to Dobutamine

d)

Dobutamine is what we use for positive inotropes

e)

Digoxon can be used to manage HF symptoms long term

40.

Which describes subset IIII?

a)

Cold

b)

Wet

c)

Dry

d)

Warm

41.

What is the first thing that needs to be addressed in a Subset IIII pt?

a)

Cold

b)

Wet

c)

Dry

d)

Warm

42.

Which problem is a 1st priority problem?

a)

Perfusion

b)

Congestion

c)

Edema

d)

BP

e)

HR

43.

What is a first line vasopressin?

a)

Norepinephrine

b)

Epinephrine

c)

Dopamine

d)

Dobutamine

44.

______ may help to calm them down when they are on a ventilator?

a)

Morphine

b)

Fentanyl

c)

Oxycodone

d)

Nicotine

45.

What does COLD met in subset terms?

a)

Hypoperfused

b)

Hyperperfused

c)

Congested

d)

Normal

e)

High BP

46.

Select the two that mean a person is a normal subset?

a)

Warm

b)

Dry

c)

Wet

d)

Cold

47.

What is a good indicator of well perfusion?

a)

>2.2 L/min/m2

b)

Warm

c)

<2.2 L/min/m2

d)

Cold

48.

Which indicates fluid overload?

a)

>18 mmHg

b)

<12 mmhG

c)

12-17 mmHg

d)

>16 mmHg

e)

1 mg

49.

What level of pulmonary artery occlusion pressure do you want to be at?

a)

12-18 mmHg

b)

>18 mmHg

c)

<12 mmHg

50.

What is considered COLD subset symptoms?

a)

Signs of hypoperfusion

b)

Blue lips

c)

BP low

d)

High HR

51.

Select all that apply: What would be considered in the WARM subset?

a)

Normal BP

b)

OK perfusion

c)

Organs OK

d)

Edema

e)

SOB

52.

What would be considered in the DRY subset?

a)

SOB

b)

No SOB

c)

JVD

d)

No JVD

e)

Edema

53.

What would be considered in the WET subset?

a)

SOB

b)

JVD

c)

Edema

d)

Dehydration

e)

Blue lips

54.

What are the GOALS for subset IIII?

a)

Restore perfusion

b)

Relieve congestive symptoms

c)

Optimize volume status

d)

Be able to discharge a pt that is stable

55.

What are important EFFICACY endpoints for acute HF?

a)

Weight

b)

Fluid intake/output

c)

Heart failure S/SX

d)

Hemodynamics

e)

Renal function

56.

What are safety endpoints for HF?

a)

Weight

b)

Hemodynamics (BP, MAP)

c)

Electrolytes

d)

Renal function

e)

Weight

57.

What needs to be addressed before discharging a pt for HF?

a)

Exacerbated factors addressed

b)

Optimal volume status

c)

Stable on all oral meds

d)

Education

e)

Stable with no meds

58.

Which subset's main problem is FLUID?

a)

Subset I

b)

Subset II

c)

Subset III

d)

Subset III

59.

What should you give to patient that have fluid overload?

a)

Diuretic

b)

ACEi

c)

ARB

d)

CCB

60.

Which subset's problem is hypoperfusion?

a)

Subset I

b)

Subset II

c)

Subset III

d)

Subset IIII

61.

What kills first?

a)

Congestion

b)

Perfusion

62.

Which drugs are shown to DECREASE mortality?

a)

ACEi/ARB

b)

ARNI (Entresto)

c)

BB

d)

Aldosterone Receptor Antagonists

e)

Hydralazine/Nitrates

63.

What are non-pharm treatments for those wiith acute decompensated HF?

a)

Monitor weight

b)

Sodium restriction

c)

Fluid restriction

d)

Add fluid

e)

Decrease BMI

64.

What are the MAIN pharm treatments for HF

a)

ACEi/ARB/ARNI

b)

BB

c)

Aldosterone

d)

Loops

e)

Digoxin

65.

What is used for symptoms relief for HF?

a)

Diuretics

b)

Digoxin

c)

Ivabradine (Corlanor)

d)

ACEi

e)

Hydralazine/Isosorbide

66.

Which is affected by volume of venous return or fluid status

a)

Preload

b)

Afterload

67.

Affected by aortic pressure and SVR

a)

Preload

b)

Afterload

68.

“load” the heart must overcome to eject blood

a)

Afterload

b)

Preload

69.

Which are peripheral hemodynamics?

a)

BP

b)

MAP

c)

HR

d)

CVP

e)

PAP

70.

What is the GOAL map we are shooting for?

a)

<65 mmHG

b)

>65 mmHG

c)

>45 mmHG

d)

10-15 mmHG

71.

Which describes assesses fluid status during resuscitation, it is the DIRECT measurement of BP in the right atrium

a)

CVP

b)

CO

c)

CI

d)

SVR

72.

What is the goal CVP we want to reach?

a)

8-12 mmHG

b)

12-15 mmHG

c)

1-15 mmG

d)

>65 mmHG

73.

What is the GOAL CVP if the pt is mechanically ventilated?

a)

12-15 mmHG

b)

8-12 mmHG

c)

12-15 mmHG

d)

>65 mmHG

74.

What is the Cardiac Index (L/min/m2) level that means you are WELL PERFUSED?

a)

>2.2

b)

<2.2

c)

>18

d)

<18

75.

What level means you have pulmonary edema (L/min/m2)?

a)

>18

b)

<18

c)

>2.2

d)

<2.2

76.

What is Mixed-venous oxygen saturation (Svo2) a reflection of?

a)

Oxygen delivery

b)

Tissue perfusion

c)

Surrogate markers for CO

d)

Tachycardic

e)

Determinant of which BB to use

f)

HF

77.

What is the svo2 goal?

a)

>65%

b)

>60%

c)

>55%

d)

>70%

78.

What is the goal for scvo2?

a)

>65%

b)

>70%

c)

<70%

d)

>35%

79.

What is the definition of shock?

a)

Acute state of inadequate perfusion of critical organs

b)

Blood pressure extremely low

c)

Dizziness and extreme vomiting

d)

State of confusion

80.

Which of these can shock do to your body?

a)

SBP <90 mmHg

b)

MAP <70 mmHg

c)

MAP >70 mmHg

d)

Bradycardia

e)

End organ damage 

81.

Which type of shock is consists of trauma and hemorrage?

a)

Hypovolemic

b)

Cardiogenic

c)

Obstructive

d)

Vasodilatory

82.

Which type of shock is consists of acute myocardial infarc and HF?

a)

Hypovolemic

b)

Cardiogenic

c)

Obstructive

d)

Vasodilatory

83.

Which type of shock is consists of trauma and hemorrhage?

a)

Hypovolemic

b)

Cardiogenic

c)

Obstructive

d)

Vasodilatory

84.

Which type of shock is consists of cardiac tamponade, pneumothorax and pulmonary emboli?

a)

Hypovolemic

b)

Cardiogenic

c)

Obstructive

d)

Vasodilatory

85.

Which type of shock is consists of sepsis, anaphylaxis and neurogenic?

a)

Hypovolemic

b)

Cardiogenic

c)

Obstructive

d)

Vasodilatory

86.

When talking about vasodilator or distributive shock which condition are we addressing?

a)

Pre-resuscitation

b)

Post-resusitation

87.

Choose the two shocks that are very similar in presentation

a)

Hypovolemic

b)

Cardiogenic

c)

Obstructive

d)

Vasodilatory

e)

Pre-resuscitation

88.

What would a SBP <90 mmHg likely cause?

a)

Hypotension

b)

Tachycardia

c)

Hyperventilation

d)

Cutaneous vasoconstriction

e)

Liguria

89.

What would a HR > 90 bpm likely cause?

a)

Hypotension

b)

Tachycardia

c)

Hyperventilation

d)

Cutaneous vasoconstriction

e)

Liguria

90.

What would a RR > 20 bpm likely cause?

a)

Hypotension

b)

Tachycardia

c)

Hyperventilation

d)

Cutaneous vasoconstriction

e)

Liguria

91.

What would a UOP <20 mL/hr likely cause?

a)

Hypotension

b)

Tachycardia

c)

Hyperventilation

d)

Cutaneous vasoconstriction

e)

Liguria

92.

What is a sign of cutaneous vasoconstriction?

a)

Cold

b)

Clammy extremities

c)

Edema

d)

Confusion

e)

Altered mental state

93.

What is a indictor of sepsis?

a)

Hyperthermia

b)

Hypothermia

c)

Leukocytes WBC > 12 x 103/mm3

d)

Thrombocytopenia

e)

Leukopenia WBC <4 x 103/mm3

94.

Select the evidence of organ hypoperfusion

a)

Neuro: altered mental status

b)

CV: altered hemodynamics, elevated troponin, EKG changes

c)

Respiratory: decrease oxygen saturdation

d)

GI: decrease bowel sounds, ileus, incrased LFTs, PT/INR and PTT

e)

Renal: Decrease UOP

95.

What are the 4 stages of treatment:

a)

Salvage

b)

Optimization

c)

De-escalation

d)

Stabilization

e)

Replenish

96.

For the Salvage phase what is our target?

a)

Lactate clearance

b)

MAP > 65 mm Hg

c)

MAP <65 mmHg

d)

Fluid replenish

97.

What is our main goal for Optimization stage?

a)

Target MAP >65 mmHg

b)

Target MAP < 65 mmHG

c)

Target lactate clearance

d)

Target euvolemia

98.

What are the fluids of choice for fluid resuscitation?

a)

Normal saline

b)

Lactated ringers

c)

H2O

d)

PDE 5%

99.

How do you evaluate a stopping point for fluids?

a)

Passive leg raise

b)

Hemodynamics parameters

c)

Pitting check

d)

BP measurement

e)

Cognitive tests

100.

How do you administer vasopressins and inotropes for shock?

a)

Central line

b)

Peripheral line

c)

Orally

101.

Which induce vasoconstriction -> Increase SVR and MAP

a)

Inotrope

b)

Vasopressor

c)

ACEi

d)

ARB

e)

Digoxin

102.

Which increase rate and contractility -> increase CO and MAP?

a)

Vasopressin

b)

Inotrope

c)

ARB

d)

ACEi

e)

CCB

103.

You should avoid doses >0.125 of Digoxin if:

a)

Age >60

b)

Age >70

c)

Impaired renal function

d)

Low BMI

e)

High BMI

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