Advanced Med-Surg Cardiac

Front 1

What proteins are released from severely damaged myocardial tissues cells

Back 1

Cardiac biomarkers;
The biomarkers that are routinely measured include cardiac triponin I (cTnI), cardiac troponin T (cTnT) and CK-MB.

Hint 1

When myocardial cells are damaged they release detectable proteins into the bloodstream to that a rise in biomarkers can be correlated with myocardial cellular cellular damage.

Front 2

What diagnostic tests are used for diagnosis of cardiovascular disorders?

Back 2

Frequent BP monitoring, cardiac catheterization and echocardiograms

Front 3

Increased levels of what are a marker for heart failure?

Back 3

BNP

Front 4

Test myoglobin and risk for coronary artery disease (HCT and LDL) to assess for what?

Back 4

myocardial infarction

Front 5

Cardiac troponins start to elevate how long after myocardial injury and are specific to the myocardium?

Back 5

4-6 hours

Front 6

_______ is specific to myocardial injury and infarction but does not increase until __ hours after the infarction occurs.

Back 6

Creatine kinase (CK-MB);
6 hours

Front 7

LDL cholesterol and C-reactive protein are useful in assessing __________ risk but are not helpful in determining whether a patient is having an _______.

Back 7

cardiovascular risk;
acute myocardial infarction

Front 8

What test is contraindicated for patients with implanted metallic devices such as pacemakers?

Back 8

MRI

Front 9

Stress Test-ECG changes associated with coronary ischemia (such as T-wave inversions and ST depression) indicate what?

Back 9

That the myocardium is not getting adequate oxygen delivery and that the exercise test should be terminated immediately

Front 10

What things are normal during aerobic exercise and as the intensity of exercise increases during stress testing?

Back 10

BP and HR are normal responses to aerobic exercise.
Tiredness is normal as the intensity of exercise increases during the stress testing.

Front 11

The contrast dye used for the procedure is iodine based, so patients who have shellfish allergies will require treatment with which medications before an arteriogram?

Back 11

corticosteroids and antihistamines

Front 12

A patient will need to be NPO how many hours preceding the TEE?

Back 12

6 hours; the nurse should place the patient on NPO status as soon as the order is received

Hint 12

Other actions need to be accomplished but NPO will take the longest.

Front 13

Systemic vascular resistance

Back 13

is mean pressure difference across the systemic vascular bed, divided by blood flow

Front 14

Systemic vascular resistance

Back 14

represents the resistance against which the left ventricle must pump to eject its volume

Front 15

Jugular venous distention

Back 15

this is seen when central venous pressure is elevated, which occurs with fluid volume overload and right ventricular dysfunction

Front 16

The parameters for normal sinus rhythm are:

Back 16

HR 60-100 beats/minute; rhythm regular; PR interval 0.12-0.2 second; and QRS, 0.06-0.1.

Front 17

Controlled hypertension

Back 17

is a situation in which administration of antihypertensive medications maintains the patient's blood pressure within the normal range

Front 18

Coronary heart disease

Back 18

is a progressive atherosclerotic disorder of the coronary arteries that results in narrowing or complete occlusion

Front 19

The major hemodynamic effect of CAD is the distrubance in the delicate balance between:

Back 19

myocardial oxygen supply and demand

Front 20

Pulse deficit

Back 20

is a difference between simultaneously obtained apical and radial pulses and indicates that there may be a cardiac dysrhythmia that would be detected with ECG monitoring.

Front 21

The valsalva maneuverwould be performed to to what?

Back 21

decrease the heart rate.

Front 22

Lidocaine HCL (Nervocaine, Octocaine)

Back 22

Antiarrhythmic, Class IB; Anesthetic
Exerts antiarrhythmic action by suppressing automaticity in His-Purkinje system of the heart and elevates electrical stimulation threshold of ventricle during diastole. Prompt, intense, and longer-lasting local anesthetic than procaine.

Front 23

Diltiazem (Cardizem)

Back 23

Calcium channel blocking agent; antianginal; antihypertensive
Slows the SA and AV node conduction (antiarrhythmic effect). Dilates coronary artery spasms; thus myocardial oxygen delivery is increased (antianginal effect). By vasodilation of peripheral arterioles, drug decreases total peripheral vascular resistance and reduces arterial BP at rest (antihypertensive effect)

Front 24

Epinephrine (EpiPen)

Back 24

Reverses analphylactic reactions and provides temporary relief from acute asthmatic attack. Restores normal cardiac rhythm.

Front 25

Adenosine (adenocard)

Back 25

Antiarrhythmic
Restores normal sinus rhythm in patients with paroxysmal supraventricular tachycardia.

Front 26

Dopamine HCL

Back 26

Cardiac stimulant; vasopressor
Due to its potential for inotropic, chronotropic and vasopressor effects, dopamine has several clinical uses, including decreased cardiac output as well as correcion of hypotension associated with cardiogenic and septic shock

Front 27

Norepinephrine bitartrate (Lecophed)

Back 27

Vasopressor; cardiac inotropic;
Peripheral vasoconstriction and moderate inotropic stimulation of heart result in increased systolic and diastolic BP, myocardial oxygenation, coronary artery blood flow, and workload of the heart

Front 28

Amiodarone HCL (cordarone)

Back 28

Antiarrhythmic; Antianginal
By direct action on smooth muscle, decreases peripheral resistance and increases coronary blood flow. Blocks effects of sympathetic stimulation.

Front 29

Nitroprusside Sodium (Nitropress)

Back 29

Antihypertensive; Vasodilator
Effective antihypertensive agent used for rapid reduction of high blood pressure.

Front 30

Why is tachycardia detrimental to anyone with ischemic heart disease?

Back 30

Because it decreases the time for ventricular filling, decreases stroke volume and thus compromises cardiac output and myocardial oxygenation.

Front 31

Central lines and arterial lines can monitor what?

Back 31

Pressure

Front 32

What can affect how the pressure wave is transferred to the transducter and can cause damped waveforms? What can correct the damping?

Back 32

Blood, kinks or air bubbles in the tubing.
Aspirating the blood or air or removing kinks can correct the damping

Front 33

Although _____ are frequently present after a MI, they are not always benign.

Back 33

PVCs

Front 34

If the patient does not appear symptomatic from the PVCs at the time, what medication is not indicated?

Back 34

Lidocaine

Front 35

How are PVCs controlled initially?

Back 35

By administering oxygen to reduce myocardial hypoxia and by correcting acid-base or electrolyte imbalances.

Front 36

What is one recognized physiological effect of HDL?

Back 36

The ability of HDL to promote the efflux of cholesterol from cells.

Hint 36

This process may minimize the accumulation of foam cells in the artery wall and thus decrease the risk of developing atherosclerosis.

Front 37

High ______ levels confer both anti-inflammatory and antioxidant benefits on the arterial wall. In contrast, a low ______ level is an independent risk factor for the development of CAD and other atherosclerotic conditions.

Back 37

HDL

Front 38

When the onset of V tach symptoms is rapid, the most likely mechanism of death is ventricular tachycardia (VT), which degenerates into what?

Back 38

Ventricular fibrillation (VF)

Front 39

Reduction or cessation of what type of medications usually results in sodium and water retention, which may precipitate heart failure?

Back 39

Diuretics

Front 40

Unstable angina

Back 40

a change in a previously established stable pattern of angina. It is part of the continuum of acute coronary syndrome (ACS).

Hint 40

Unstable angina is more intense than stable angina; it may awaken the person from sleep or may necessitate more than nitrates for pain relief.

Front 41

A patient with unstable angina may exhibit what?

Back 41

Nonspecific or nonelevated ST-segment changes on the 12 lead ECG.

Front 42

What is visible after the pacing artifact if the atrium is being paced?
if the ventricle is being paced?
with dual-chamber pacing?

Back 42

A P-wave
A QRS complex
A pacing artifact precedes both the P-wave and the QRS complex

Front 43

The _______ is the spike that is seen on the ECG tracing as the pacing stimulus is delivered to the heart.

Back 43

pacing artifact

Front 44

Stents are inserted to optimize the results of other treatments for what two things?

Back 44

Acute vessel closure (percutaneous transluminal coronary angioplasty, atherectomy, fibrinolytics) and to prevent restenosis.

Front 45

If a distal pulse cannot be palpated using light finger pressure what can be used?

Back 45

A doppler ultrasonic is helpful.

Front 46

What test is an evaluation of blood flow to and pulse quality in the hand by assessment of the radial and ulnar arterial pulses and when is this test performed?

Back 46

The Allen test; it is performed before insertion of an arterial line

Front 47

Capillary refill assment is a maneuver that uses the patient's nail beds to evaluate what?

Back 47

Arterial circulation to the extremity and overall perfussion.

Front 48

The severity of arterial insufficiency is directly proportional to what?

Back 48

The amount of time necessary to reestablish flow and color.

Front 49

The presence of S3 in the presence of cardiac symptoms is an indication of what?

Back 49

Increased ventriculat volume suggestive of heart failure with fluid volume overload.

Front 50

Auscultation of S4 is also referred to as what?

Back 50

atrial gallop

Front 51

What should be expected when S4 (artial gallop) is auscultated?

Back 51

heart failure and decreased ventricuar compliance.

Front 52

On an ECG, evidence of an infarction is seen by the presence of what?

Back 52

A pathological Q-wave

Front 53

After administration of morphing, the nurse assesses the pt for pain relief and the development of unwanted side effects such as what?

Back 53

hypotension and respiratory depression

Front 54

What is the most common complication of IABP support?

Back 54

lower extremity ischemia secondary to occlusion of the femoral artery, either by the catheter itself for by emboli from thrombus formation on the balloon.

Hint 54

Evaluation of peripheral circulation remains an important nursing assessment.

Front 55

The presence and quality of peripheral pulses distal to the catheter insertion site are assessed frequently along with what other things?

Back 55

Color, temp and capillary refill of the involved extremity.

Front 56

When the patient is lying flat, the jugular veins are at the level of the right atrium and so JVD is a common (but not clinically significant) finding. If JVD that persists when the pt is sitting at __________, this is significant.

Back 56

30-45 degree angle or greater

Front 57

JVD is an expected finding when a pt performs _____ because the right atrial pressure increases.

Back 57

Valsalva maneuver

Hint 57

The nurse will document the JVD in the record if it persists when the head of the bed is elevated.

Front 58

Why should the carotid pulses never be palpated at the same time?

Back 58

to avoid vagal stimulation, dysrhythmias and decreased cerebral blood flow.

Front 59

What is calculated by using the formula
____ = (systolic BP = 2 diastolic BP) /3

Back 59

The mean arterial pressure (MAP)

Front 60

In an aerobically trained individual what heart rhythm is normal?

Back 60

sinus bradycardia

Front 61

Hypokalemia increases the risk for what?

Back 61

ventricular dysrhythmias such as PVCs, ventricular tachycardia and V-fib.

Hint 61

the health care provider will need to prescribe a potassium infusion to correct this abnormality

Front 62

If a patient is experiencing symptomatic bradycardia what type of treatment would be appropriate?

Back 62

Treatment with a trans cutaneous pacer (TCP)

Front 63

If a pt is non-symptomatic to bradycardia what is an adequate response?

Back 63

continued monitoring of the rhythm and BP

Front 64

What are the s/s of PEA?

Back 64

The pt's clinical manifestations indicate pulesless electrical activity the nurse should immediately start CPR

Front 65

What does the P wave represent in an EKG?

Back 65

the depolarization of the atria

Front 66

What does the P-R interval represent in an EKG?

Back 66

depolarization of the atria, AV node, bundle of His, bundle branches and the Purkinje fibers

Front 67

What does the QRS segment represent in an EKG?

Back 67

ventricular depolarization

Front 68

What does the Q-T interval represent in an EKG?

Back 68

depolarization and repolarization of the entire conduction system

Front 69

What describes a rhythm in which every other QRS complex is wide and bizarre looking?

Back 69

Ventricular bigeminy

Front 70

What are pairs of wide QRS complexes described as?

Back 70

couplets

Front 71

When is a PVC multifocal?
Unifocal?

Back 71

Multifocal when they look different in comparison to the other PVCs;
Unifocal when they all look the same.