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423 Cards in this Set
- Front
- Back
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What is the difference between positive inotropic agents and negative inotropic agents?
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Positive inotropic agents increase contractility and negative inotropic agents decrease contractility.
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Why do people with heart failure cough and get SOB?
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blood backs up into the lungs
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In right heart failure, the blood backs up into the veins, resulting in ___ and engorgement of the organs.
a) peripheral edema b) hypertrophy of aorta c) ventricular tachycardia d) asystole |
a) peripheral edema
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What are the side effects of ace inhibitors?
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hypotension, syncope, angioedema, and blood dyscrasias
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What are the side effects of Loop diuretics?
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hypotension, dehydration, hypokalemia, hyponatremia, ototoxicity
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What are the side effects of thiazide and thiazide like diuretics?
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hypotension, dehydration, hypokalemia, hyponatremia
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What are the side effects of potassium-sparing diuretics?
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dysrythmias due to hyperkalemia
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What are the side effects of beta-adrenergic blockers?
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Steven-Johnson syndrome, anaphylaxis, agranulocytosis
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What are the side effects of vasodilators?
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headache, flushing, ortho hypertension, dizziness, reflex tachycardia
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What are the side effects of cardiac glycosides?
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N/V, headache, visual disturbances(yellow-green tinge) blurring, dysrythmias, AV block
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What are the side effects of phosphodiesterase inhibitors?
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headache, hypotension and dysrythmias
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Unless contraindicated, all clients with HF and many clients at high risk for HF should receive ___.
a) atropine b) epinephrine c) morphine d) ace inhibitor |
d) ace inhibitor
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What are the 2 main actions of an ace inhibitor?
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lower peripheral resistance and inhibit aldosterone secretion, which reduces blood volume
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Most medications ending in "pril" are classified as:
a) loop diuretics b) thiazide diuretics c) beta-adrenergic blockers d) ace inhibitors |
d) ace inhibitors
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Cardiac drugs ending in "ide"
are most likely: a) diuretics b) vasodilators c) beta-adrenergic blockers d) ace inhibitors |
a) diuretics
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Cardiac meds ending in "lol" are:
a) loop diuretics b) thiazide diuretics c) beta-adrenergic blockers d) ace inhibitors |
c) beta-adrenergic blockers
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What type of cardiac med is Digoxin?
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Cardiac glycoside
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What type of cardiac med is spironolactone?
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a potassium-sparing diuretic
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What type of cardiac med is lisinopril?
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ace inhibitor
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What type of cardiac med is Lasix?
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loop diuretic
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What type of cardiac med is Metoprolol?
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beta-adrenergic blocker
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What type of medication is HCTZ?
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Thiazide diuretic
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The nurse should pay special attention to the lab work of the patient taking what 2 medications together?
a) lisinopril, spironolactone b) Coreg, lisinopril c) lasix, Coreg d) Metoprolol, lasix |
a) lisinopril, spironolactone: hyperkalemia may result!
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How do beta-blockers work?
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They block the sympathetic nervous system, thus slowing the heart rate.
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True or False: The doctor has decided to start a patient on Coreg, a beta-blocker. The normal dosage of Coreg for a patient with HF is 25 mg. The patient is told to take 25 mg once daily to start.
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False: Beta-blockers are started at 1/10 or 1/20 of the target dose, and doses are doubles every 2 weeks until the optimum dose is reached. If dosing is increased too quickly or began at too high a dose, the HF could worsen.
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Who are beta-blockers contraindicated in? Check all that apply:
a) diabetes b) hypertension c) COPD d) bradycardia e) heart block |
c) COPD
d) bradycardia e) heart block |
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When would you decided to hold the dose of Metoprolol, a beta-blocker?
a) HR greater than 100 b) HR less then 60 c) blood pressure less then 90/60 d) blood pressure greater than 120/80 |
b) HR less than 60: remember beta-blockers are contraindicated in patients with bradycardia!
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What medication can be used to reverse bradycardia?
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atropine
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How do vasodilators work?
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They relax blood vessels and lower blood pressure.
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Your kardex says to administer Isordil 0.5 mg. What would you do prior to administering this dose?
a) check BP b) check HR c) listen to lung sounds d) take an apical pulse |
a) check blood pressure, this medication will lower blood pressure!
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How do cardiac glycosides work?
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They make the heart beat more forcefully but slower, improving cardiac output.
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What would you want to check prior to administering Digoxin, a cardiac glycoside?
a) check HR b) check BP c) listen to lungs d) palpate liver border |
a) check HR: if its less than 60, don't administer and call the MD
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What lab test should you check prior to administering Digoxin?
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serum Digoxin levels
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What is an acceptable serum Digoxin level, for a patient on Digoxin?
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1.8
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Digoxin is known to have what effects on sodium and potassium?
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lowering them both
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What is Digoxin immune Fab(Digibind) used for?
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Digoxin toxicity
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True or False: Patients on Digoxin are recommended to avoid potassium containing foods.
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False: They should consume potassium containing foods since they are at risk for low potassium.
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What foods contain a lot of potassium?
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bananas, apricots, kidney beans, sweet potatoes, and peanut butter
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Is Digoxin usually a short term or long term therapy?
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short term: 2-3 days
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The client is prescribed Digoxin for treatment of HF. Which of the following statements by the client indicates the need for further teaching?
a) "I may notice my heart rate decrease" b) I may feel tired during early treatment c) This drug will help my heart muscle pump less d) "my heart rate will speed up" |
d) this drug will help my heart muscle pump less
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The nurse reviews lab studies of a client receiving Digoxin. Intervention by the nurse is required if the results include a:
a) serum dig level of 1.2 b) serum potassium of 3.0 c) hemoglobin of 14.4 d) serum sodium of 140 |
b) serum potassium of 3.0
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Nursing interventions during initial therapy with ACE inhibitors must include:
a) monitoring EKG b) monitoring intake and output c) monitoring blood pressure d) monitoring serum levels |
c) monitoring BP
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The teaching plan for a client receiving thiazide diuretics should include:
a) taking an apical pulse b) including citrus fruit, melons, and vegetables in diet c) decreasing potassium-rich foods in the diet d) checking blood pressure three times daily |
b) including citrus fruit, melons, and vegetables in diet; remember that diuretics cause loss of potassium
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Lisinopril is part of the treatment regimen for a client with HF. The nurse monitors the client for the side effects of this drug which may include(check all that apply
a) hyperkalemia b) hypokalemia c) cough d) dizziness e) headache |
a) hyperkalemia
c) cough d) dizziness e) headache |
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True or False: In both stable and variant angina, NTG decreases the cardiac oxygen demand by dilating veins and decreasing venous return.
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False: That is true for stable angina, but for variant angina, NTG relaxes or prevents spasm in the coronary arteries, thus increasing oxygen supply.
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Jessica was just prescribed a nitroglycerin for her heart. What common side effects should you advise her of?
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Headache, orthostatic hypotension, reflex tachycardia, and tolerance.
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True or False, Metoprolol (Lopressor) or another beta-blocker can be prescribed to treat the reflex tachycardia associated with nitroglycerin.
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True!!!
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Why is NTG contradicted in patients with traumatic head injury?
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It will cause an increase in intracranial pressure.
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Why is alcohol use contradicted in patients taking NTG?
a) can cause hypertension b) can cause hypotension c) can cause renal failure d) can cause liver damage |
b) can cause hypotension
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Before starting NTG, what should you ask the male patient and why?
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Ask if they are taking Viagra since concurrent use with NTG can cause life-threatening hypotension.
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True or False: A client should be instructed to take NTG when chest pain is severe.
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False: The client should take NTG at the first sign of chest pain, and not wait until the pain is severe.
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How are sublingual NTG tablets stored?
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In the original bottle, in a cool dark place.
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True or False: A client is instructed to take NTG prior to activity that is known to cause chest pain, such as climbing a flight of stairs.
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True!
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Patient teaching of the client using a transdermal NTG patch would include what:
a) remove the patch at bedtime b) apply the patch at bedtime c) cut the patch in half at bedtime d) cover the patch with an occlusive dressing at bedtime |
a) remove the patch at bedtime- to reduce the risk of developing tolerance to NTG; the client should be medication free a minimum of 8 hrs each day; preferably at night
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Which forms of NTG are used for long term prophylaxis?
a) sublingual b) Translingual c) Transmucosal d) Oral capsule e) Transdermal f) Topical ointment g) IV |
c) Transmucosal
d) Oral capsule e) Transdermal f) Topical ointment |
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What special measures are taken for the patient receiving IV NTG?
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Continuous heart rate and blood pressure monitoring.
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What special container is IV NTG administered in?
a) light block bottle b) glass bottle c) plastic bottle d) Nitrite bottle |
b) glass bottle
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Your husband has been prescribed sublingual NTG. You of course carry this bottle with you at all times. While you two are going for a walk, he grabs his chest and says he is experiencing chest pain. What is your first step?
a) give him a nitro pill b) flag down a car and go to the hospital c) call 911 from your cell phone d) have him sit down/discontinue activity |
d) have him sit down/discontinue activity
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Your husband has been prescribed sublingual NTG. You of course carry this bottle with you at all times. While you two are going for a walk, he grabs his chest and says he is experiencing chest pain. What do you do after giving him a nitro pill?
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Wait 5 minutes, and give him another nitro pill if the pain is still unrelieved; it is now time to call 911 or drive to the emergency room.
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How do class IA sodium channel blockers work?
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They decrease electrical conduction, increase automaticity, and decrease the rate of repolarization
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How do class IB sodium channel blockers work?
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They decrease electrical conduction, decrease automaticity, and increase rate of repolarization.
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How do class IV calcium channel blockers work?
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They decrease the force of contraction, decrease heart rate, and slow the rate of conduction through the AV node.
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What type of antidysrhythmic is used only for ventricular dysrythmias?
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class IB sodium channel blockers
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What type of antidysrhythmic is used for the conversion of atrial fibrillation?
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class III potassium channel blockers
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What type of antidysrhythmic medication act to: decrease the rate of repolarization, electrical conduction, contractility, and automaticity?
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Class III potassium channel blocker.
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What is systemic lupus syndrome and what is it associated with?
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It is painful, inflamed joints that is a side effect of the antidysrhythmic Proncainamide (Pronestyl).
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True or False: Lupus titers are drawn on patients taking the antidysrhythmic procainamide (Pronestyl) who experience painful joints.
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False: ANA titers are drawn and monitored for increases.
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Why might a CBC be drawn on a patient taking the antidysrhythmic procainamide (Pronestyl)?
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To monitor for neutropenia
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Cardiotoxicity, a possible side effect of the antidysrhythmic Procainamide (Pronestyl), is identified by what change on the ECG?
a) widened QRS complex b) shortened QRS complex c) widened PR complex d) shortened PR complex |
a) widened QRS complex
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What medication can be administered to control seizure activity associated with the antidysrhythmic medication procainamide (Pronestyl)?
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Dilantin
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The primary purpose of an anticoagulant is:
a) prevent platelets from sticking together b) dissolve clots that have already formed c) prevent clots and the formation of fibrin |
c) prevent clots and the formation of fibrin
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What is the primary purpose of antiplatelets?
a) prevent platelets from sticking together b) dissolve clots that have already formed c) prevent clots and the formation of fibrin |
a) prevent platelets from sticking together
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What is the primary purpose of a thrombolytic agent?
a) prevent platelets from sticking together b) dissolve clots that have already formed c) prevent clots and the formation of fibrin |
b) dissolve clots that have already formed
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Medications that promote the production of specific bone marrow cells are termed:
a) anticoagulants b) antiplatelets c) thrombolytic agents d) hematopoietic growth factors e) anti-anemic agents f) blood replacement agents |
d) hematopoietic growth factors
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How does heparin act as an anticoagulant?
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Prevents the formation of fibrin
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What is the antidote for heparin overdose?
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protamine sulfate
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What lab parameter is monitored if a patient is on heparin?
a) RBC b) aPTT c) PT/INR d) Iron |
b) aPTT
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In addition to the aPTT, what other lab test should the nurse monitor during heparin infusion?
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Platelets
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Heparin therapy should be discontinued if the client's platelet count is less than:
a) 150 b) 125 c) 100 d) 75 |
c) 100
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Prior to administering heparin, what should the nurse do?
a) check the BP b) check the blood sugar c) check the med with another nurse d) check the iron level |
c) check the med with another nurse
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What is a therapeutic aPTT level for a patient on heparin?
a) 10-20 sec b) 15-45 sec c) 30-50 sec d) 60-80 sec |
d) 60-80
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A patient on heparin has an aPTT of 20 seconds. How should their heparin be changed?
a) it should be increased b) it should be decreased c) it should not be changed |
a) it should be increased since a therapeutic aPTT is 60-80
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What is monitored several times daily until a therapeutic heparin dosage is determined?
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aPTT (Duh!!!)
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A patient on heparin is given a deep SC injection. What is done afterwords?
a) aPTT is drawn b) CBC is drawn c) PT/INR is drawn d) pressure is applied for 1-2 minutes e) blood pressure is taken |
d) pressure is applied to the injection site for 1-2 minutes because of the increased risk for bleeding and slower clotting times.
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How does coumadin act as an anticoagulant?
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It antagonizes vitamin K, thereby preventing the synthesis of clotting factors and prothrombin
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What 2 conditions is coumadin commonly prescribed for?
a) bed rest b) a-fib c) prosthetic heart valve d) aortic stent e) hemophilia |
b) a-fib
c) prosthetic heart valve |
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If a person is hemorrhaging what would happen to their heart rate and blood pressure?
a) heart rate increases, BP increases b) heart rate decreases, BP decreases c) heart rate increases, BP decreases d) heart rate decreases, BP increases |
c) heart rate increases, BP decreases
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What is the antidote for coumadin overdose?
a) Vitamin A b) protamine sulfate c) Vitamin K d) IV dextrose |
c) Vitamin K
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What specific lab value is monitored before and during Coumadin therapy?
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PT/INR
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True or False: If anticoagulation is needed during pregnancy, heparin can be safely substituted for coumadin.
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True
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Patients taking coumadin should avoid the concurrent use of what other medication?
a) insulin b) iron c) folic acid d) glucocorticoids |
d) glucocorticoids
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What effect do the following medications have, with concurrent use with coumadin...phenobarbital, carbamazepine (Tegretol), phenytoin (Dilantin), oral contraceptives, and vitamin K.
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they decrease the anticoagulant effects with concurrent use
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What do the following foods have in common: dark green leafy vegetables, cabbage, cauliflower, soybeans.
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They are high in vitamin K and can decrease the anticoagulant effects with excessive intake
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What is a therapeutic PT for a patient on coumadin? (in seconds)
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18-24 sec
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What is a therapeutic INR for a patient on coumadin?
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2-3
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A patient has coumadin ordered. You look up the INR, and it is 3.5. What do you do?
a) administer the coumadin b) hold the coumadin and call then doctor c) administer the coumadin and then call the doctor |
b) hold the coumadin and then call the doctor: the therapeutic INR should be 2-3 so the anticoagulant should be held to prevent bleeding; and the doctor needs to be notified.
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True or False: Heparin and coumadin must never be administered together due to the risk of bleeding with concurrent use.
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False: Since clients do not experience anticoagulant effects from warfarin for 8-12 hours with full therapeutic effect being achieved in 3-5 days, continued heparin infusion is needed when started on oral warfarin.
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True or False: Patients taking coumadin are encouraged to wear a medical alert bracelet at all times.
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True
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What can be done to prevent gum bleeding?
a) floss before brushing(Sheila) b) use listerine mouth wash c) use a hard bristled tooth brush d) massage the gums vigorously after mouth care |
None of the above, those listed will cause further irritation! Use a soft-bristled tooth brush instead!
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What do streptokinases do?
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Dissolve clots!
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A patient with an active internal bleed goes for a CT-Scan of their leg. It reveals a blood clot. The doctor orders Streptase. What do you do?
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You do not give it! Since the patient has an active internal bleed, you could put them in serious danger by giving them a medication that dissolves blood clots!
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True or False:
The client receiving streptokinase should be monitored for hypertension. |
False: They should be monitored for hypotension: If you are bleeding out somewhere, you bp is going to DROP and your heart rate is going to INCREASE.
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How long do you have to administer thrombolytic agents following the onset of symptoms?
a) 1 hour b) 2-4 hours c) 3-5 hours d) 4-6 hours |
d) 4-6 hours
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Why would you administer Zantac or Prilosec with an anticoagulant?
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The Zantac or Prilosec will reduce irritation and ulcers in the stomach, thereby reducing the increased risk of bleeding associated with anticoagulant therapy.
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You can expect signs and symptoms of thrombosis to decrease how long after administration of a streptokinase?
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60-90 minutes
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A nurse receives an order to administer normal saline at 50 mL/hr. Which of the following lines may be used for administration? Check all that apply:
a) peripheral IV site b) arterial line c) proximal lumen of PA catheter d) distal lumen of PA catheter |
a) peripheral IV site
c) proximal lumen of PA catheter |
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Can you infuse IV fluid through an A-line?
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no
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Nursing responsibilities of the patient who just received a PA line include:
a) insertion of the line b) suturing of the line to the skin c) ordering an xray to check placement d) zeroing the system |
d) zeroing the system with atmospheric pressure by lining the transducer to the phlebostatic axis and then opening it to the air and reclosing it.
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A patient has the following symptoms: crackles, jugular vein distension, hepatomegaly, peripheral edema, taut skin turgor. Which of the following does she most likely have?
a) elevated preload b) decreased preload c) elevated afterload d) decreased afterload |
a) elevated preload
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A patient has the following symptoms: warm extremities and bounding peripheral pulses. Which of the following does she most likely have?
a) elevated preload b) decreased preload c) elevated afterload d) decreased afterload |
d) decreased afterload
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A patient has the following symptoms: cool extremities and weak peripheral pulses. Which of the following does she most likely have?
a) elevated preload b) decreased preload c) elevated afterload d) decreased afterload |
c) elevated afterload
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A patient has the following symptoms: poor skin turgor and dry mucous membranes. Which of the following does she most likely have?
a) elevated preload b) decreased preload c) elevated afterload d) decreased afterload |
b) decreased preload
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What is the first thing the nurse will do when obtaining a reading from a hemodynamic catheter?
a) lower the head of the bed b) raise the head of the bed c) zero the system d) raise the whole bed |
a) lower the head of the bed: place the client in the supine position prior to recording hemodynamic values, the HOB may be elevated 15-30 degrees if needed
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Beta-Blocker can cause bradycardia, bronchospasm and what other side effect?
a) hyperglycemia b) hypoglycemia c) peripheral neuropathy d) migraines |
b) hypoglycemia
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What medication is often given to increase a slow heart rate?
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atropine
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What are some of the atypical symptoms that women have during myocardial ischemia?
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dyspnea, nausea and weakness
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Looking at cholesterol, the goal is to have ___ LDLs and ___ HDLs.
a) low, low b) high, high c) high, low d) low, high |
d) low LDLs and high HDL
*remember H for high, you want high HDLs |
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What dietary element can help enhance the excretion of metabolized cholesterol, and is found in fresh fruit, cereal grains, vegetables, and legumes?
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soluble fiber
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Typical medications that affect lipoprotein metabolism have what effect on LDLs, HDLs, and TGs?
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Lower LDLs
Raise HDLs Lower TG(triglycerides) |
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How are Bile Acid Sequestrants different from typical lipid lowering meds?
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They have no effect or can actually raise your triglycerides; but they still lower LDLs and raise HDLs.
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Which of the following contribute to the incidence and severity of CAD?
a) high fiber intake b) cigarette smoking c) pregnancy d) steroid use |
b) cigarette smoking
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True or False: Repeated blood pressures above 120/80 is defined as hypertension.
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False: hypertension is defined as blood pressure measurements that repeatedly exceed 140/90. However, blood pressures repeatedly above 120/80 are considered prehypertensive and at risk.
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What is the physiologic origin of angina?
a) high bp b) low bp c) low O2 d) low CO2 |
c) low O2; you feel chest pain when the need for oxygen exceeds the supply in the coronal blood flow
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What is the most common presenting symptom of the elderly person with angina?
a) chest pain b) bounding pulse c) dyspnea d) all of the above |
c) dyspnea-the elderly person with angina may not exhibit the typical pain profile because of the diminished responses of the neurotransmitters that occur with aging.
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What is the primary pharmacological treatment for angina?
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Nitroglycerin
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Nitroglycerin would be withheld in the patient complaining of chest pain in which of the following situations?
a) BP of 100/75 b) pulse of 60 c) BP of 90/58 d) pulse of 100 |
c) BP of 90/58
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A patient currently takes NSAIDs or other analgesics for back pain. Their doctor prescribes a 1-a-day 81 mg aspirin as a preventative measure to cardiac complications. The patient asks you if he should take the aspirin even if he is taking other NSAIDs.
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Yes-patients should be advised to continue aspirin even if they concurrently take NSAIDs.
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Heparin therapy is usually considered therapeutic when the aPTT is ___ to ___ times the normal aPTT value.
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1.5-2.5
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Why would a patient admitted with angina have an ECG taken with special attention paid to the ST-segment and T waves?
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To help rule out an MI as the underlying cause of the chest pain.
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What are the 3 classic changes on the ECG that occur with an MI?
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ST-segment elevation, T-wave inversion, and an abnormal Q wave
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What would you diagnose a patient with, if they have the clinical manifestations of coronary ischemia, but ECG or cardiac biomarkers show no evidence of acute MI?
a) angina b) unstable angina c) ST-segment elevation MI d) Non-ST segment elevation MI |
b) unstable angina
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Looking at an ECG, what would an abnormal Q wave or decreased height of the R wave without ST-segment and T-waves changes indicate?
a) an old ST-segment elevation MI b) a current ST-segment elevation MI c) a developing Non-ST-segment elevation MI d) none of the above |
a) an old ST-segment elevation MI
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____ tests are currently recognized as reliable and critical markers of myocardial injury; and can be detected within a few hours during acute MI and remain elevated for as long as 3 weeks.
a) Total CK b) CK-MB c) Myoglobin d) Troponin |
d) Troponin
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Which of the following medications is a patient with a suspected MI given? Check all that apply:
a) aspirin b) nitroglycerin c) morphine d) beta-blocker |
All of them while the diagnosis is being confirmed!
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Why would a patient suspected of having an MI be given morphine?
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To reduce pain and anxiety which in turn reduces the workload of the heart.
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True or False: Prior to administering an ace inhibitor, it is important to check that the patient is not hypotensive, hyponatremic, hypovolemic, or hyperkalemic.
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True
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You know the patient has been properly educated when he says ___ about phase I of cardiac rehabilitation.
a) "It begins after I am discharged" b) "I will learn about long term conditioning c) "It began when I was first diagnosed" d) "This phase can last up to 6 months" |
c) "It began when I was first diagnosed"- and it consists of low level activities and initial education for the patient and family
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You know the patient has been properly educated when he says ___ about phase II of cardiac rehabilitation.
a) "It begins 2 months after I am discharged" b) "I will learn about long term conditioning c) "It began when I was first diagnosed" d) "This phase can last up to 6 months" |
d) "This phase can last up to 6 months"-Phase II occurs after the patient has been discharged and usually lasts for 4-6 weeks but may last as long as 6 months; The outpatient programs consists of supervised exercise training that is individualized based on the results of an exercise stress test. Support and guidance are also provided.
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You know the patient has been properly educated when he says ___ about phase III of cardiac rehabilitation.
a) "It begins after I am discharged" b) "I will learn about long term conditioning c) "It began when I was first diagnosed" d) "This phase can last up to 6 months" |
b) "I will learn about long term conditioning"- This is the maintenance phase in which the patient is self directed and maintains the goals of phase II independently.
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What additional step is taken with a patient who underwent a coronary artery stent placement?
a) antibiotics are prescribed for 4-6 weeks b) bed rest is prescribed for 2-3 days c) antiplatelets are prescribed for 3-6 months d) iron containing vitamins are avoided for 3-6 weeks |
c) antiplatelets are prescribed for 3-6 months because of the risk of thrombus formation in the stent
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Following a coronary artery stent placement, the patient may return to the postoperative unit with the large peripheral vascular access sheath in place. When can these be removed, and are there any special activity restriction while these are in place?
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They can be removed after blood studies reveal that clotting times are within normal range. The patient must remain flat in bed and keep the affected leg straight until the sheaths are removed and then for a few hours afterward to maintain hemostasis.
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A patient that is dehydrated would have high or low urine specific gravity?
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high urine specific gravity
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Following cardiac surgery, how much drainage from the chest tube is expected to be collected per hour during the first 4-6 hours?
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200 per hour
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ECG changes, tall peaked T waves, wide QRS, and brachycardia are manifestations of what electrolyte inbalance?
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hyperkalemia
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A patient with overhydration would have high or low urine specific gravity?
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low
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What medication can be given to lower potassium?
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Kayexalate
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What valve separates the right atrium from the right ventricle?
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Tricuspid
*remember righT has the T for Tricuspid |
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The primary pacemaker of the heart is:
a) bundle of his b) AV node c) SA node d) ventricular pacemaker |
c) SA node
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What valve separates the left atrium from the left ventricle?
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Mitral
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A patient with a heart rate of 75 is most likely being paced by the:
a) SA node b) AV node c) Ventricle d) Atria |
a) SA node: It has the highest inherent rate (60-100 impulses per minute).
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A patient has a heart rate of 35 beats per minute. What is most likely acting as the pacemaker?
a) SA node b) AV node c) ventricle d) atria |
c) ventricle- ventricular pacemakers sites have the lowest inherent rate (30-40 impulses per minute)
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A patient has a heart rate of 45 beats per minute. What is most likely the pacemaker of their heart?
a) SA node b) AV node c) ventricle d) atria |
b) AV node- It has the second-highest inherent rate (40-60 impulses per minute)
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True or False: Several circumstances make the heart more susceptible to early depolarization during the absolute refractory period, thus increasing the risk for serious dysrythmias.
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False: Several circumstances make the heart more susceptible to early depolarization during the RELATIVE (not absolute) refractory period, thus increasing the risk for serious dysrythmias.
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How do you calculate cardiac output?
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Multiply stroke volume by the heart rate.
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____ refers to the degree of stretch of the cardiac muscle fibers at the end of diastole.
a) preload b) midload c) afterload d) sclerotic degree |
a) preload
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____ is the amount of resistance to ejection of blood from the ventricle.
a) preload b) midload c) afterload d) sclerotic degree |
c) afterload
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What is the relationship between afterload and stroke volume?
a) the bigger the afterload the bigger the stroke volume b) the smaller the afterload the smaller the stroke volume c) the bigger the afterload the smaller the stroke volume |
c) the bigger the afterload the smaller the stroke volume: Ok, so if the resistance to blood ejection(afterload) is high, then less blood will be pumped out of the heart(stroke volume), therefore giving an inverse relationship.
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The percentage of blood ejected from the heart with each stroke is termed ___ ___.
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ejection fraction
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Who would have more risks undergoing a cardiac catheterization, a man or a woman? Why?
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A woman because the coronary arteries of a woman are smaller, they occlude from atherosclerosis more easily, making procedures such as cardiac catheterization and angioplasty technically more difficult
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What might a diabetic patient feel instead of chest pain?
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fatigue or shortness of breath- because of neuropathies
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A common symptom of heart failure includes:
a) frequent urination during the day b) frequent urination after standing for long periods of time c) frequent urination after sitting for long periods of time d) nocturia |
d) nocturia- Its common in patients with heart failure because fluid collected in the dependent tissues during the day redistributes into the circulatory system once the patient is recumbent at night.
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Who is at greatest risk for coronary artery disease?
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Ready for this one: Old Black Obese Males, who are inactive diabetics, and smoke with hypertension.
I.E Risk factors are: Male gender African American Race Old Age Obesity Smoking Hypertension Diabetes High cholesterol Inactivity |
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What might you caution the MALE patient about prior to starting a beta-blocker?
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It may cause impotence :(
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Who would you suspect has high cholesterol:
a) the 250 lb 55 year old who was SOB coming up 1 flight of stairs b) the 25 year old female recently diagnosed with xanthelasma c) the 150 lb diabetic with diet controlled diabetes d) the 200 lb female who just had a baby |
b) the 25 year old female recently diagnosed with xanthelasma: these are yellowish, slightly raised plaques in the skin which may be observed along the nasal portion of one or both eye lids and may indicate elevated cholesterol levels
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Dehydration is suspected when a postural change results in a increased heart rate and either a decrease in systolic pressure by ___ mm or a decrease in diastolic pressure by __ mm Hg.
a) 15, 10 b) 10, 15 c) 15, 15 d) 10, 10 |
a) 15. 10 So...the dehydrated person's heart rate will increase and their BP will drop with changing positions.
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What is the difference between a 0 and a +4 in a pulse quality rating?
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0=no pulse
+4=strong and bounding |
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A patient with observed pulsations of the jugular veins of the neck is suspected of having ___ sided heart failure.
a) left b) right c) dual d) anterior e) posterior |
b) right
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What causes you to hear S1 and S2?
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The closing of the heart valves.
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What valves close during S1?
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Mitral and Tricuspid
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What valves close during S2?
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aortic and pulmonic
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When heart sounds come in triplets and have the acoustic effect of a horse, what is this termed?
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a gallop
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How is the patient positioned to best hear and S3 gallop?
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on their left side
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How do you test the hepatojugular reflex?
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Press firmly over the right upper quadrant of the abdomen for 30 to 60 seconds and note an increase of 1 cm or more in the jugular vein(1cm or more increase indicates a cardiovascular disorder)
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True or False: An S4 is heard in about 90% of elderly patients.
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True!!!
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What are the first enzyme levels to increase in an acute MI?
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CK and CK-MB
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True or False: A patient with increased levels of Lactic dehydrogenase most likely had an MI that day.
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False: Those levels don't peak until 2-3 days after the event.
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True or False: A positive diagnosis of an MI can be made on a patient with an elevated Myoglobin.
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False: Myoglobin is not used alone to diagnose MI, because elevation can also occur in patients with renal or musculoskeletal disease.
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The normal range for triglycerides is 100-200.
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The normal range for triglycerides is 100-200.
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What is the normal range for triglycerides?
a) 50-100 b) 100-200 c) 200-300 d) 180-200 |
b) 100-200
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What is the normal range for triglycerides?
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100-200
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___ is a neurohormone that helps regulate BP and fluid volume.
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BNP
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A BNP level of ___ or greater is correlated with mild heart failure.
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51.2
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True or False: C-Reactive Protein(CRP) is used to help predict cardiovascular disease risk.
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True!
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If significant EKG abnormalities occur during the exercise stress test, further diagnostic testing such as a ___ is required.
a) xray b) MRI c) angiogram d) CT-scan |
c) angiogram
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True or False, a patient is allowed to eat prior to a pharmacological stress test.
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False: Theophyline and other xanthines, such as caffeine, block the effects of the dipyridamole and adenosine and must be avoided before stress tests.
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What can the patient expect to feel during the pharmacological stress test?
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flushing or nausea as the vasodilating agent is injected
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Which of the following could be a complication for a pt who is scheduled for a TEE?
a) low bp b) heart murmur c) dysphagia d) syncope |
c) dysphagia
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How can a doctor differentiate between areas of infarction and areas of ischemia during a Myocardial Perfusion Imaging test?
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Several hours later, resting images are taken, and the ischemic areas will have taken up the contrast, but the infarction areas will never take up the contrast.
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What if a patient is scheduled for an MRI but they tell you they are claustrophobic?
a) cancel the test b) sedate them c) hang a morphine bag d) call the family |
b) sedate them: a mild sedative beforehand will help make the test much more bearable
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How long is pressure applied to the femoral site, after the cardiac catheterization?
a) 30 seconds b) 1-3 minutes c) 5 minutes d) 4-10 minutes |
d) 4-10 minutes
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What might you assess the patient for following a cardiac catheterization?
a) enlarged pancreas b) distended bladder c) deviated trachea d) rectal bleeding |
b) distended bladder: A vasovagal reaction consisting of bradycardia, hypotension, and nausea, can be precipitated by a distended bladder or by discomfort during removal of the arterial catheter, especially if a femoral site has been used. Prompt intervention is critical
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What steps are taken if a patient is recognized as having a vasovagal reaction after a cardiac catheterization?
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Raise feet and legs above heart level, administer IV fluids and atropine.
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What is the activity level after a cardiac cath?
a) amb with assistance b) up to a chair c) BRP d) bed rest |
d) bed rest
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Describe the electrophysiologic test.
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The heart is electrically stimulated to try to induce the known dysrythmias. When it is found, antiarrhythmia meds are administered until the correct one is found(the one that corrects the dysrythmia).
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During the set up of central venous pressure monitoring system, the stop cock of the transducer is positioned where?
a) 3 feet from the ground b) the height of the side rail c) the height of the chest d) the level of the right atrium |
d) the level of the right atrium- this is referred to as the phlebostatic level
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What is the range for a proper CVP through the A-line?
a) 0-8 b) 12-16 c) 30-45 d) 115-145 |
a) 0-8
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A standard 12-lead EKG refects the electrical activity primarily in which chamber?
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left ventricle
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What is the difference between a positive and negative deflection?
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Positive deflection- EKG waveform moves towards the top of the paper
Negative defection-EKG waveform moves towards the bottom of the paper |
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What is a normal PR interval?
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0.12-0.20
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A heart rate greater than ___ would qualify as sinus tach.
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100
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True or False: If the rapid rate in sinus tach does not resolve, the patient may develop acute pulmonary edema.
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True!
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Which cardiac strip has the appearance of the "saw tooth"?
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A-flutter
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Which is more significant, A-flutter or A-fib?
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A-fib
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What is a major risk with A-fib?
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blood clots! (you better have gotten that right!)
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What medication is initially given to correct A-flutter?
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Adenosine
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What is the treatment for unstable A-flutter?
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cardioversion
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Which is more dangerous, A-fib or V-fib?
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V-fib
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What is the primary treatment for V-fib?
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Immediate CPR or defibrillation
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A major difference between cardioversion and defibrillation is the timing of the delivery of electrical current. In cardioversion, the delivery of the electrical current (is/is not) synchronized with the patient's electrical events. In defibrillation, the delivery of the current (is/is not) synchronized.
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cardioversion- IS synchronized
defibrillation- is NOT synchronized |
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____ is yelled ___ times before pressing the discharge button on the defibrillator paddles.
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"Clear" is yelled 3 times.
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Are patients generally intubated for cardioversion?
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No- generally respiration is supported with supplemental oxygen delivered by a bag-mask valve device with suction equipment readily available, although intubation equipment is nearby if needed
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Which of the following patients with a pacemaker should receive additional instructions:
a) a professional juggler b) a dentist c) a limo driver d) a mechanic |
d) a mechanic- they should not work with running engines, they should be turned off to prevent interference from the magnetic field
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True or False: Patients with pacemakers should not use cell phones.
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False: They are instructed to use the phone on the opposite side of the pacemaker and not to carry the phone in their shirt pocket.
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What precautions should the patient with the newly implanted pacemaker be given, related to airport security?
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Do not go through metal detectors and request a hand search; no hand held wand searches.
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The pacemaker for the entire myocardium is the:
a) atrioventricular junction b) bundle of His c) Purkinje fibers d) sinoatrial node |
d) sinoatrial node
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An example of a Beta-blockers that is administered to decrease automaticity is:
a) Cardizem b) Lopressor c) Cordarone d) Rythmol |
c) Lopressor
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The difference between the systolic and the diastolic pressure is called the:
a) pulse pressure b) auscultatory gap c) pulse deficit d) Korotkoff sound |
a) pulse pressure
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If the sphygmomanometer cuff is too small for the patient, the blood pressure reading will probably be:
a) falsely elevated b) falsely decreased c) still accurate d) significantly different with each reading |
a) falsely elevated
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The first heart sound is generated by:
a) closure of the aortic value b) closure of the AV valves c) opening of the AV valves d) opening of the pulmonic valve |
b) closure of the AV valves
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The nurse auscultates the apex of the heart by placing a stethoscope over:
a) Erb's point b) the fifth intercostal space c) the pulmonic area d) the tricuspid area |
b) the fifth intercostal space
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The total time for ventricular depolarization and repolarization is represented on an EKG as the:
a) QRS complex b) QT interval c) ST segment d) TP interval |
B) QT interval
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Ventricular rhythm can be determined by examining what interval on the EKG strip?
a) PP b) QT c) RR d) TP |
c) RR
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The PR interval on an EKG strip that reflects normal sinus rhythm would be between:
a) 0.05-0.10 sec b) 0.12-0.20 sec c) 0.15-0.30 d) 0.25-0.40 |
b) 0.12-0.20
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Describe the person in V-fib.
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No heartbeat, no pulses, no respirations!
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The most common cause heart disease for adults in the US is:
a) angina pectoris b) CAD c) MI d) valvular heart disease |
b) CAD
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Hypertension is present with repeated blood pressure measurements exceeding:
a) 110/80 b) 120/80 c) 139/90 d) 140/90 |
d) 140/90
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The incidence of CAD tends to be equal for men and women after the age of:
a) 45 b) 50 c) 55 d) 65 |
c) 55
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The PAIN of angina pectoris is produced primarily by:
a) coronary vasoconstriction b) movement of thromboemboli c) myocardial ischemia d) the presence of atheromas |
a) coronary vasoconstriction
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A common side effect of nitroglycerin is:
a) musculoskeletal weakness b) hypertension c) bradycardia d) headache |
d) headache
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The scientific rationale supporting the administration of beta-adrenergic blockers is the drugs' ability to:
a) block sympathetic impulses to the heart b) elevate blood pressure c) increase myocardial contractility d) induce bradycardia |
a) block sympathetic impulses to the heart
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An antidote for beta-blockers that is used to treat bradycardia is:
a) Digoxin b) atropine c) protamine sulfate d) sodium nitroprusside |
b) atropine
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Calcium channel blockers act by:
a) decreasing SA node automaticity b) increasing AV node conduction c) increasing the heart rate d) creating a positive inotropic effect |
a) decreasing SA node automaticity
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The classic EKG changes that occur with an MI include all of the following except:
a) an absent p wave b) an abnormal Q wave c) T wave inversion d) ST segment elevation |
a) an absent p wave
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The most common site of myocardial infarction is the:
a) left atrium b) left ventricle c) right atrium d) right ventricle |
b) left ventricle
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To assess peripheral edema, which of the following are particular areas for examination?
a) under the sacrum b) fingers, hands c) legs, toes d) lips, earlobes |
b) fingers, hands
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Which of the following changes occur to the heart as a result of heart transplantation?
a) heart beats faster than the natural heart b) the heart takes less time to increased the heart rate in response to exercise c) there are no sig changes notes in the heart d) heart beats slower than the natural heart |
a) heart beats faster than the natural heart(usually 100-110)
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When the post-cardiac surgical patient demonstrates vasodilation, hypotension, hyporeflexia, slow gastrointestinal motility (hypoactive bowel sounds), lethargy, and respiratory depression, the nurse suspects which of the following electrolyte imbalances
a) hyperkalemia b) hypomagnesemia c) hypermagnesemia d) hypokalemia |
c) hypermagnesemia
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Heparin therapy is usually considered therapeutic when the patient's activated partial thromboplastin time (aPTT) is how many times normal?
a) 0.5 to 1 b) 0.25 to 0.75 c) 2.5 to 3 d) 1.5 to 2.5 |
d) 1.5 to 2.5
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What is a goal LDL level?
|
under 100
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The patient with cardiac failure is taught to report which of the following symptoms to the doctor?
a) persistent cough b) increased appetite c) ability to sleep through the night d) weight loss |
a) persistent cough
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When the postcardiac surgery patient demonstrates restlessness, nausea, weakness, and peaked T waves, the nurse reviews the patient's serum electrolytes anticipating which abnormality?
a) hypomagnesemia b) hyponatremia c) hyperkalemia d) hyperkalemia |
d) hyperkalemia
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When the nurse observes that the patient's heart rate increases during inspiration and decreases during expiration, the nurse reports that the patient is demonstrating:
a) sinus bradycardia b) normal sinus rhythm c) sinus tachycardia d) sinus dysrhythmia |
d) sinus dysrhythmia
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Which of the following nursing interventions should a nurse perform to reduce cardiac workload in a patient with myocarditis?
a) elevate the patient's head b) administer supplemental O2 c) maintain the patient on bed rest d) administer a prescribed antipyretic |
c) maintain the patient on bed rest
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Which of the following ECG waveforms characterizes conduction of an electrical impulse through the left ventricle?
a) QRS complex b) P wave c) QT interval d) PR interval |
a) QRS complex
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Which of the following nursing interventions should a nurse perform when a patient with cardiomyopathy receives a diuretic?
a) check for dependent edema regularly b) administer oxygen c) maintain bed rest |
a) check for dependent edema regularly
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An asymptomatic client discusses with a nurse mitral regurgitation and inquires about continuing exercises. Which of the following responses should a nurse give the client?
a) avoid any type of exercises b) continue exercises until mild symptoms develop c) avoid strenuous exercises d) take ample rest after exercise |
b) continue exercises until mild symptoms develop: exercise is not limited until mild symptoms develop
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During auscultation of the heart, what is revealed by an atrial gallop?
a) hypertensive heart disease b) turbulent blood flow c) heart failure d) diseased heart valves |
a) hypertensive heart disease: The extra heart sound(S4) is associated with hypertensive heart disease
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Which of the following is the most important part of the postoperative assessment conducted by the nurse for patients undergoing cardiac surgery?
a) assess for mental alertness b) assess blood sugar c) assess for inadequate tissue perfusion d) assess for activity intolerance |
c) assess for inadequate tissue perfusion (assessing mental status is usually the first thing, but if the patient is a fresh post op, their mental status most likely has not yet returned to baseline as they will still be experiencing changes due to the anesthesia)
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After undergoing cardiac surgery, a patient discovers a painless lump and complains to the nurse about the same. How will the nurse address this situation?
a) reassure the patient and direct the client to the physician b) reassure the patient by informing him or her that the lump will disappear with time c) inform the patient that the lump will be removed by the surgeon d) reassure the patient by informing him or her that the lump will disappear after a course of drug therapy |
b) reassure the patient by informing him or her that the lump will disappear with time
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Which term is used to describe the ability of the heart to initiate an electrical impulse?
a) conductivity b) contractility c) excitability d) automaticity |
d) automaticity
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Which term is used to described the ability of the specialized electrical cells of the cardiac conduction system to contract in response to an electrical impulse?
a) conductivity b) contractility c) excitability d) automaticity |
b) contractility
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Which term is used to described the ability of the specialized electrical cells of the cardiac conduction system to transmit an electrical impulse from one cell to another?
a) conductivity b) contractility c) excitability d) automaticity |
a) conductivity
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Which term is used to described the ability of the specialized electrical cells of the cardiac conduction system to contract in response to an electrical impulse?
a) conductivity b) contractility c) excitability d) automaticity |
c) excitability
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Which of the following discharge instructions for self-care should the nurse provide to a patient who has undergone a percutaneous transluminal coronary angioplasty (PTCA) procedure?
a) refrain from sex for 1 month(yeah right) b) clean the site with soap and water and remove the dressing c) clean the site with disinfectants and dress the wound appropriately d) client can drive a vehicle or mow the lawn within a day |
b) clean the site with soap and water and remove any dressing
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Which of the following methods to induce hemostasis after post-PTCA removal is the least effective?
a) application of a pneumatic compression device, such as Fem-Stop b) Direct manual pressure c) application of a sandbag to the area d) application of a vascular closure devise, such as Angio-Seal, VasoSeal, Duett, or Syvek patch |
c) application of a sandbag to the area-it has not been shown to be effective in reducing the incidence of bleeding
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Which of the following nursing interventions must a nurse perform when administering prescribed vasopressors to a client with a cardiac dysrhythmia?
a) administer every 5 minutes during cardiac resuscitation b) keep patient flat for 1 hour after administration c) monitor vital signs and cardiac rhythm d) document heart rate before and after administration |
c) monitor vital signs and cardiac rhythm(which includes checking the HR before and after administration)
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Central venous pressure is measured in which of the following heart chambers?
a) left atrium b) right ventricle c) left ventricle d) right atrium |
d) right atrium
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When measuring the BP is each of the patient's arms, the nurse recognizes that in the normal adult, the pressures:
a) may vary 10 mm Hg or more between arms b) may vary, with the higher pressure found in the left arm c) differ no more than 5 mm Hg between arm pressures d) must be equal in both arms |
c) differ no more than 5 mm Hg between arm pressures
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Which of the following ECG characteristics is usually seen with a patient's serum potassium level is low?
a) P wave b) T wave c) QT interval d) U wave |
d) u wave
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Which of the following should the nurse assess before administering thrombolytic agents to older patients?
a) recent streptococcal infections b) recent skin irritation c) recent hair loss d) recent joint pains |
a) recent streptococcal infections- may decrease the effectiveness of thrombolytic agents
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PVCs are considered precursors of V-tach when they:
a) have the same shape b) are paired with a normal beat c) occur at a rate of more than 6 per minute d) occur during the QRS complex |
c) occur at a rate of more than 6 per minute
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What electrolyte imbalance is described by the following: hypotension, low heart rate, absence of deep tendon reflexes.
|
hypermagnesium-remember the heart is bathed in a magnesium bath to stop is during open heart surgery
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What electrolyte imbalance is described by the following: presence of a U wave.
|
hypokalemia
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What electrolyte imbalance is described by the following: hypertension, high heart rate.
|
hypomagnesium-the opposite symptoms of hypermagnesia!...who's a genius!
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|
What is the most common cause of death after an MI?
a) cardigenic shock b) cardiac arrhythmia c) heart failure d) pulmonary embolism |
b) cardiac arrhythmia(heart failure is 2nd most common)
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A patient presents with jugular vein distention, hepatomegaly and right upper quadrant pain. What type of heart failure do they most likely have?
|
right sided heart failure
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A patient presents with dyspnea, crackles and tachycardia. What type of heart failure do they most likely have?
|
left-sided heart failure
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|
True or False:
With mitral valve prolapse, fatigue may occur regardless or activity level and amount of rest or sleep and SOB is not correlated with activity levels or pulmonary function. |
True!
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|
What assessment finding may be indicative of mitral valve prolapse?
a) a mitral click b) a Tricuspid click c) a semi-lunar click d) aortic click |
a) a mitral click
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|
True or false, chest pain that does not respond to nitrates may respond to calcium channel blockers or beta-blockers.
|
True!
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|
Is mitral valve prolapse hereditary?
|
Yes! First degree relatives should be evaluated if a positive diagnosis is made in a patient, since S&S can go undetected.
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A patient scheduled for a colostomy insertion tells you that he has a mitral valve prolapse. What is your response?
a) cancel the surgery b) reschedule the surgery c) consult the physician about prophylactic antibiotics d) proceed with the surgery |
c) consult with the physician about prophylactic antibiotics
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|
What is the most common cause of mitral valve regurgitation?
|
rheumatic heart disease
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|
What diagnostic test provides the best images of the mitral valve?
a) EKG b) echocardiogram c) MRI d) TEE |
d) TEE
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What is medication(s) are given to treat mitral valve regurgitation?
a) lasix and beta-blockers b) calcium channel blockers c) nitro and lasix d) ace inhibitors |
d) ace inhibitors to decrease afterload
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What is a clinical manifestation of mitral value stenosis?
a) left ventricle enlargement b) right ventricle enlargement c) left atrium enlargement d) right atrium enlargement |
c) left atrium enlargement
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|
What are some symptoms of mitral stenosis?
|
hemoptysis, cough, orthopenia, and PND(paroxysmal nocturnal dyspnea)
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|
What is paroxysmal nocturnal dyspnea?
|
Waking up in the middle of the night, not being able to breath.
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What physical change in the heart can be expected with aortic regurgitation?
a) left ventricle enlargement b) right ventricle enlargement c) left atrium enlargement d) left ventricle enlargement |
a) left ventricle enlargement
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What are 2 landmark signs of aortic regurgitation?
a) widened pulse pressure b) narrow QRS complexes c) water-hammer pulse d) absent R waves |
a) widened pulse pressure and
c) water-hammer pulse |
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What medications are used to treat aortic regurgitation?
|
Calcium channel blocker and ACE inhibitors
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What change happens to the heart in aortic stenosis?
|
hypertrophy of the ventricular wall
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True or False: Prosthetic valve replacement is preferred over valvuloplasty because the new valves are more durable and require less follow up surgery.
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False: Valvuloplasty is preferred because patients do not require continuous anticoagulation and the valve actually lasts longer.
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What type of Tricuspid valve replacement is indicated for women of child bearing age, patients older than 70, hx of peptic ulcer disease?
a) xenografts b) homografts c) autografts d) micrografts |
a) xenografts- they are tissue valves from pigs usually, which do not require anticoagulant therapy
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What type of graft lasts the longest (more than 20 years)?
a) xenografts b) homografts c) autografts |
c) autografts
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What is an autograft made from?
a) pig valves b) human cadaver valves c) the patient's own pulmonic valve tissue |
c) the patient' own pulmonic valve tissue
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How long is the patient who undergoes a tissue valve replacement required to undergo anti-coagulation therapy?
a) 2-3 days b) 3 months c) 6 months d) life-long |
b) 3 months
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Patients who undergo a septal repair should take which of the following medication for 6 months postoperatively?
a) thrombolytic agent b) ACE inhibitor c) lasix d) antibiotics |
d) antibiotics- this is to prevent infective endocarditis; if minimal or no hemodynamic abnormality is evident by Doppler echocardiography after 6 months, antibiotic prophylaxis may be discontinued
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What medication can a patient who received a heart transplant expect to take?
a) lasix b) angiotensive inhibitor c) calcium channel blocker d) cyclosporine |
d) cyclosporine- an immunosuppressant that greatly decreases the body's rejection of foreign proteins
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What is the risk for taking cyclosporines?
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You are at a high risk for infection due to the immunosuppression effect of the cyclosporine. Your body has a decreased ability to mount an immune response.
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True or False: A patient with a hx of a heart transplant presents with bradycardia. The ER doctor orders 1mg of atropine to increase the dangerously low HR.
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False: Transplanted hearts do not respond to atropine or other meds that effect the sympathetic and vagus nerves because there are no nerve connection to the new heart.
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A patient tells you she heard from her friend that if you get a heart transplant, you will no longer feel chest pain. What do you tell her?
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That is true! The new heart is denervated; it has no nerve connections to the recipient's body!
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True or False: Alcoholics, pregers, and those with recent illness are at an increased risk for cardiomyopathy.
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True! (Sorry Jess!)
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People with group A beta-hemolytic streptococcal infections are at risk for:
a) pulmonary edema b) meningitis c) rheumatic fever d) GI disruptions |
c) rheumatic fever
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Staphylococcal endocarditis infections of the valves in the right side of the heart are common among:
a) children b) African Americans c) Asians d) IV drug users |
d) IV drug users
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A patient with endocarditis will receive antibiotic therapy, usually penicillin, for how long?
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2-6 weeks
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True or False: Patients diagnosed with endocarditis will need to remain in the hospital and be monitored during the 2-6 week antibiotic therapy.
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False: They can receive parenteral therapy at home!
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Cough is often associated with ___ heart failure.
a) right ventricular b) right atrial c) left ventricular d) right atrial |
c) left ventricular
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ACE inhibitor drugs end in
a) pril b) lol c) ide d) one |
a) pril: examples- benazepril, captopril, enalalpril, lisinopril, quinapril, ramipril
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Antacids, cough syrups, and laxative are contraindicated in patient on what restriction?
a) potassium b) antihistamine c) sodium d) Vitamin K |
c) sodium- all those meds contain sodium and are contraindicated in patients with heart failure
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True or False: The patients with acute heart failure (pulmonary edema) are asked to refrain from dangling their legs off the edge of the bed, as it will cause venous stasis and blood clots.
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False: They are recommended to dangle their legs off the edge of the bed to decrease the workload on the heart by decreasing venous return. This helps to decrease lung congestion.
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Describe the acid-base changes that occur during cardiogenic shock.
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Initial tachypnea results in respiratory Alkalosis; as the kidneys begin to shut down, metabolic acidosis results.
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What acid-base inbalance is INITIALLY revealed in the patient in cardiogenic shock?
a) Metabolic Acidosis b) Metabolic Alkalosis c) Respiratory Acidosis d) Respiratory Alkalosis |
d) Respiratory Alkalosis
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The most reliable sign of cardiac arrest is:
a) a low pulse ox b) bluish tinge of the lips c) a flat line on the cardiac monitor d) absence of a pulse |
d) absence of a pulse
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What is the first thing you check in a person suspected of cardiac arrest?
a) pulse b) blood pressure c) pupil constriction d) proper contact of electrodes |
a) pulse- don't waste your time checking the others!
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What is the first thing you do when you find an unconscious adult?
a) administer 2 rescue breaths b) activate the EMS c) administer 30 chest compressions d) administer 2 shocks via defibrillator |
b) activate EMS
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What is the first thing you do with to the unconscious adult when the ECG monitor suddenly shows ventricular tachycardia or ventricular fibrillation?
a) administer 2 rescue breaths b) administer 30 chest compressions c) administer 2 mg atropine d) immediately defibrillate |
d) immediately defibrillate
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Standard chest compression are ___ times per minute, with a compression to ventilation ratio of ___ to ___ .
|
100 per minute: with 30:2 compression to ventilation ratio
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The more the myocardial fibers are stretched just prior to contraction:
a) the more forcefully they will contract b) the less forcefully they will contract c) the degree of stretch has nothing to do with the subsequent contraction |
a) the more forcefully they will contract
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Where is the PMI located?
|
5th intercostal space, mid-clavicular line
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Trace the blood flow through the heart.
|
IVC, RA, tricuspid, RV, semilunar valvue Pulmonary A, Lungs, Pulmonary V, LA, Mitral(bicuspid), LV, semilunar valvu, Aorta
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At what rate does the AV node conduct impulses?
|
40-60
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The QRS represents:
a) ventricular contraction b) atrial contraction c) atrioventricular contraction |
a) ventricular contraction
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How long is the ideal ventricular contraction(QRS interval)?
|
.06- .10 seconds
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The PR interval represents:
a) ventricular contraction b) atrial contraction c) perkinge fiber stimulation d) SA node depolarization |
b) atrial contraction
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How many large boxes represent 1 minute?
|
300
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If there is a beat on every other large box, what is the rate?
|
150 beats per minute
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If there is a beat on every 3rd large box, what is the rate?
|
100
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What heart irregularity is described by the following: PR intervals that continue to get longer and longer until a QRS is skipped.
|
2nd degree heart block
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What medication is given to increase the heart rate in 2nd degree heart block?
|
Atropine
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In addison to administering atropine to increase heart rate in a person diagnosed with 2nd degree heart block, what else can be done to stimulate the heart rate?
a) vagal stimulation b) ambulation at a fast rate c) application of an external pacemaker d) valsalva maneuver stimulation |
c) application of an external pacemaker
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Looking at an EKG strip, how can you tell if a person has hyperkalemia?
|
peaked T waves
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How can you determine from looking at an EKG strip if a person has hypokalemia?
|
low T waves
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True or False: A person with hypokalemia should be given Digoxin to help increase their potassium.
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False: Digoxin should not be given as it will further lower their already low potassium.
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A patient can be diagnosed with unstable angina based on the following symptoms:
a) pain is not relieved with rest, not relieved by nitro b) pain is relieved by rest and nitro c) pain radiates down left arm and is shown evidence by elevated ST segments on EKG |
a) pain is not relieved by rest and nitro
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What is Prinzmetal Angina?
a) a leakage of the coronary artery b) dilation of the coronary artery c) stenosis of the coronary artery d) spasm of the coronary artery |
d) spasm of the coronary artery
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True or False: Prinzmetal Angina is a spasm of the coronary artery related to high oxygen demand during increased physical activity or times of stress.
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False: it is unrelated to oxygen demand
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Who is Prinzmetal Angina common in?
a) IV drug users b) diabetics c) alcoholics d) N-stage liver failure |
b) diabetics
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What does the "Red dress" program address?
a) blood borne illnesses b) menstrual awareness programs c) cardiac issues in women d) equality issues in society |
c) cardiac issues in women- women have atypical cardiac distress symptoms which are commonly misdiagnosed
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True or False: Following an MI, the damaged area of the heart can be fixed with rest and adequate oxygenation.
|
False: The damaged area of the myocardium is permanently damaged.
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What activity will be ordered for a patient who just had an MI?
a) bed rest b) BRP c) ambulate with O2 d) activity as tolerated |
a) bed rest- to decrease the workload on the heart
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What is a normal Troponin level?
|
.01-.1
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A patient who is scheduled for a cardiac catheterization should have which lab value checked?
a) Hematocrit b) WBC c) BUN/Creatinine d) AST/ALT |
c) BUN/Creatinine-they should have good kidney function in order to be able to excrete the dye injected during the test
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What medication is given to promote renal excretion of dye for patients with a history of renal failure?
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mucomyst
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What is done after the PTCA to ensure that the vessel doesn't just re-collapse?
|
A stent is placed to maintain patency
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The nurse would implement which of the following measures following a PTCA.
a) bed rest b) fluid restriction c) lasix drip d) vagal stimulation |
a) bed rest: for 4-6 hours to prevent bleeding
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What is the ultimate treatment for cardiogenic shock?
|
A heart transplant
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The patient going for an CABG would have a blood vessel taken from the ___ or ___.
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leg or chest
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Preoperative responsibilities of the patient going down for open heart surgery include:
a) cleansing the surgical site with iodine followed by alcohol b) shaving the patient from chest to groin c) waxing all pubic hair off d) administering a blood thinner |
b) shaving off all visible hair from chest to groin
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A patient is scheduled for open heart surgery today. He is very anxious and scared about the upcoming surgery. What do you do?
a) reschedule the surgery b) call the doctor c) administer the PRN tranquilizer d) tell the patient that if they don't calm down, you will have to call security |
c) give them the PRN tranquilizer
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The doctor orders telemetry for the patient scheduled to go down for open heart surgery. How do you position the electrodes?
a) on their shoulders and back b) on the lateral sides c) on the arms and legs d) you cannot put electrodes on the patient undergoing open heart surgery, they will be in the way and will compromise the sterile field |
a) on their shoulders and back
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What does a Swan ganz measure?
a) systolic pressure b) diastolic pressure c) pulmonary artery pressure d) aortic pressure |
c) pulmonary artery pressure
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Mitral Valve stenosis prevents normal blood flow from the __ to the __.
|
left atrium to the left ventricle
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Who is aortic regurgitation common in?
a) men, athletes b) women, athletes c) men, IV drug users d) women, IV drug users |
c) men(75%), and IV drug users
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When the pericardial sac fills with fluid and puts extra pressure on the heart, what results?
a) increased preload b) cardiac tamponade c) flaccid ventricles d) decreased intra-atrial pressure |
b) cardiac tamponade
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What common pulmonary complication results from heart surgery?
a) impaired gas exchange b) metabolic Alkalosis c) respiratory Alkalosis d) ineffective breathing pattern |
a) impaired gas exchange
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What blood thinner is taken for life following a synthetic valve replacement?
a) Lovenox b) Heparin c) aspirin d) Coumadin |
d) Coumadin
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What does the mnemonic unloadme stand for, in terms of treatment for CHF?
|
U-head of bed up
N-nitrates L-lasix O-oxygen A-albuterol D-dobutamine M-morphine E-electrical cardioversion |
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|
What is the difference between systolic heart failure and diastolic heart failure?
a) systolic-weakened heart diastolic- stiff heart b) systolic- weakened heart diastolic- relaxed heart c) systolic- stiff heart diastolic- stretched heart |
a) systolic- weakened heart
diastolic- stiff heart |
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|
What is a normal EF?
|
50-70
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A normal BNP is <___.
a) 500 b) 300 c) 200 d) 100 |
d) 100
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What does the BNP measure?
|
stretching of the heart muscle
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What do you think the person experiencing the following symptoms has? restlessness, anxiety, dyspnea, cool/clammy skin, cyanosis, weak/rapid pulse, cough, lung congestion, increased sputum production, frothy sputum and decreased level of conciseness
|
pulmonary edema
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In which type of cardiomyopathy does the heart chamber expand to become thin and flaccid?
a) Dilated cardiomyopathy b) Hypertrophic cardiomyopathy c) Restrictive cardiomyopathy |
a) Dilated cardiomyopathy
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|
In which type of cardiomyopathy does the muscle become thick with a subsequent decrease in chamber size?
a) Dilated cardiomyopathy b) Hypertrophic cardiomyopathy c) Restrictive cardiomyopathy |
b) hypertrophic cardiomyopathy
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|
In which type of cardiomyopathy does the heart become rigid and stiff?
|
restrictive cardiomyopathy
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Which of the following is the most important part of the postoperative assessment conducted by the nurse for the patientt who underwent cardiac surgery?
a) assess blood sugar b) assess mental alertness c) assess activity intolerance d) assess for inadequate tissue perfusion |
d) assess for inadequate tissue perfusion-the key is POSTOPERATIVE- mental alertness may not be optimal yet due to analgesics/anesthesia
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When the nurse observes an ECG tracing on a cardiac monitor with a pattern in lead II and observes a bizarre, abnormal shape to the QRS complex, the nurse has likely observed which of the following ventricular dysrhythmias?
a) ventricular tachycardia b) ventricular bigeminy c) ventricular fibrillation d) PVC |
d) PVC
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A patient with a potassium deficiency is expected to have changes in what area of the EKG?
a) P wave b) QT interval c) U wave d) T wave |
c) U wave
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|
If a patients potassium is high, how will their EKG be effected?
|
Tall T waves
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Which of the following describes the amount of blood ejected per heartbeat?
a) ejection fraction b) afterload c) stroke volume d) cardiac output |
c) stroke volume
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Which of the following procedures most specifically describes splitting or separating fused cardiac valve leaflets?
a) valvuloplasty b) commissurotomy c) annuloplasty d) chordoplasty |
b) commissurotomy
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Which of the following symptoms occur in a patient with Mitral regurgitation when pulmonary congestion occurs?
a) hypertension b) a loud, blowing murmur c) tachycardia d) SOB |
d) SOB
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|
What is the antidote to heparin?
a) Vitamin K b) protamine sulfate c) a shot of whiskey |
b) protamine sulfate
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|
Which of the following mitral valve conditions generally produces no symptoms?
a) prolapse b) regurgitation c) infection d) stenosis |
a) prolapse
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During auscultation of the heart, what is revealed by an atrial gallop?
a) hypertensive heart disease b) turbulent blood flow c) heart failure d) diseased heart valves |
a) hypertensive heart disease
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Heparin therapy is usually considered therapeutic when the patient's activated ptt is how many times normal?
a) 9.25-0.75 b) 2.5-3 c) 0.5-1 d) 1.5-2.5 |
d) 1.5-2.5
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Remember therapeutic:
Coumadin: pt: 1.5-2 INR:2-3 Heparin PTT: 1.5-2.5 times normal |
Why r u flipping over this card, there was no question on the front! You need to get more sleep.
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What is the drug of choice for treatment of ventricular dysrhythmias?
|
amiodarone
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|
How ofter do nursing students shave their legs?
a) every day b) every other day c) once a week d) after every exam |
d) after every exam (or in Marianne's case, every other)
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|
What are we all doing after we pass our NCLEX?
a) sleeping b) watching TV c) relaxing d) attending the book burning conference |
d) attending the book burning conference
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|
The faster the heart rate, the (higher/lower) the cardiac output.
|
lower- the ventricles have less time to fill so the result is a lowered cardiac output
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|
Normal Troponins should be what value?
|
less then 0.6
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|
A nurse notes bilateral +2 edema in the lower extremities of a client with MI who was admitted 2 days ago. The nurse would plan to do which of the following next?
a) order daily weights starting on the following morning b) review in the I/O records for the last 2 days c) request a sodium restriction of 1g/day from the MD d) change the time of diuretic administration from morning to evening |
b) review the I/O records for the last 2 days
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A client with myocardial infarction is going into cardiogenic shock. Because of the risk of myocardial ischemia, for which of the following should the nurse carefully assess the client?
a) bradycardia b) ventricular dysrythmias c) rising diastolic blood pressure d) falling central venous pressure |
b) ventricular dysrythmias
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A nurse is preparing to ambulate a client on the third day after cardiac surgery. The nurse would plan to do which of the following to enable the client to best tolerate the ambulation?
a) remove telemetry equipment b) provide the client with a walker c) premedicate the client with an analgesic d) encourage the client to cough and deep breathe |
c) premedicate the client with an analgesic
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A nurse is evaluating a client's response to cardioversion. Which of the following observations would be of highest priority to the nurse?
a) BP b) status of airway c) oxygen flow rate d) level of consciousness |
b) status of airway-remember that the client is not intubated for cardioversion, so airway patency is important
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A nurse is assessing the neurovascular status of a client who returned to the surgical nursing unit 4 hours ago after undergoing aortoiliac bypass graft. The affected leg is warm and the nurse notes redness and edema. The pedal pulse is palpable and unchanged from admission. How would the nurse correctly interpret the client's neurovascular status?
a) it is normal because of the increased blood flow through the leg b) it is moderately impaired, and the surgeon should be called c) it is slightly deteriorating and should be monitored for another hour d) it is adequate from an arterial approach, but venous complications are arising |
a) it is normal because of increased blood flow through the leg
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Which of the following heart references are located at the third IC space to the left of the sternum?
a) Pulmonic area b) Erb’s point c) Tricuspid area d) Aortic area |
B) Erb's point
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|
CVP, Pulmonary artery pressure and Intra-arterial BP monitoring are all what type of monitoring?
|
hemodynamic
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|
Until ____ infants are obligate nose breathers.
a) 1 month of age b) 2 months of age c) 6 months of age d) 2 years of age |
a) 1 month of age
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|
|
Infants are abdominal breathers because:
a) they have not been taught how to breathe right b) they have weak intercostal muscles c) they diaphragms are underdeveloped and cannot rise and fall adequately d) we do not know why they do it |
b) they have weak intercostal muscles
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|
What respiratory dysfunction presents mostly among the preterm neonates related to the developmental delay in lung abnormality?
|
Respiratory Distress Syndrome
|
|
|
What are symptoms of RDS?
a) tachypnea, grunting, retractions b) bradypnea, diminished lung sounds, 1:1 anterior/posterior diameter c) bark like cough, nasal flaring |
a) tachypnea, grunting, retractions
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|
What respiratory disorder is common among babies of diabetic mothers, delivery before 37 weeks and delivery by c-section?
|
RDS(Respiratory Distress Syndrome)
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|
Immediately after delivery, the infant with RDS is:
a) intubated b) put in an incubator c) sent for a peak flow test d) dangled from a clothes line by its ankles |
b) put in an incubator
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What should the nurse do if the infant with RDS cannot maintain a PaO2 above 50?
a) intubate them b) apply CPAP c) turn the oxygen up to 15 L d) manually stimulate them every 5-10 minutes |
b) apply CPAP
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|
What condition does the following describe? Fever, chills, foul breath,dry throat, dysphagia, pain in the ears, headache, malaise, muscular pains and enlarged cervical nodes.
|
tonsillitis
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|
A child is scheduled for a tonsillectomy. Her mother tells you her last acute infection was 3 weeks ago. What do you tell her?
a) the surgery will have to be rescheduled; surgery is performed 6 weeks after an acute infection has been resolved b) we will have to administer prophylactic antibiotics because of the high risk of infection c) As long as the child has been free of acute infection for 2 weeks, we can go along with the surgery |
a) the surgery will have to be rescheduled; surgery is performed 6 weeks after an acute infection has been resolved
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|
A patient presents with halitosis, chronic sore throat, foreign body sensation or a history of expelling foul tasting and small cheesy lumps(omg).
a) Croup b) epiglotittis c) tonsillitis d) asthma e) RDS |
c) tonsillitis
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|
How should the nurse position the postoperative child, following a tonsillectomy, to facilitate drainage of secretions?
a) on their back b) head of bed raised c) on their stomachs d) on their side |
d) on their side
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|
True or False: The nurse should encourage the postoperative tonsillectomy child to cough, deep breath, and clear their throat often, to facilitate clearing of the airway.
|
False: Coughing , clearing, the throat, and blowing the nose are to be avoided as it may cause bleeding.
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|
What should you give the postoperative child, when they complain of being thirsty?
a) cool water b) cherry Popsicle c) ice cream d) pudding |
a) cool water:
cherry Popsicle- no red colored foods(might mistake it for blood) ice cream/pudding- will cause the child to have to clear their throat, and should be avoided |
|
|
Epiglotittis, supraglotittis, laryngitis, laryngotracheobroncholitis and bacterial tracheitis all are encompassed under what disorder?
|
Croup
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|
|
A patient with croup would present with what symptoms:
a) a high pitched cough b) foul smelling breath c) barky cough d) swelling of the extremities |
c) barky cough
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|
|
What are mild cases of croup treated with?
|
cool mist-humidified air
|
|
|
True or False: In the hospital setting, oxygen hood are used for infants and oxygen tents for toddlers, to provide cool mist.
|
True!
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|
What medications are used in the medical management of croup with more complications: Check all that apply
a) corticosteroids b) antibiotics c) racemic epinephrine d) lasix e) 10% Dextrose solution |
a) corticosteroids
b) antibiotics-only if epiglotittis or bacterial tracheitis c) racemic epinephrine |
|
|
True or False: Fluid volume monitoring is important in the treatment of bronchitis and RSV.
|
True
|
|
|
What age group does RSV typically affect?
a) 2-6 months b) <2 years c) 2-6 years d) any age |
b) <2 years
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|
What would be the primary diagnosis for a patient with bronchitis?
a) impaired gas exchange b) ineffective breathing pattern c) activity intolerance d) risk for anxiety |
a) impaired gas exchange-the thick mucus, exudate, and mucosal edema obstruct the smaller airways and this obstruction leads to a reduction in expiration, air trapping, and hyperinflation of the alveoli.
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|
|
Is RSV treated with antibiotics?
|
NO-its a viral infection, not bacterial
|
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|
What precautions are implemented for the patient with RVS?
a) standard b) contact c) droplet d) airborne |
b) contact
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|
|
What condition is described by the following triad of symptoms: bronchial smooth muscle spasm, inflammation/edema of the bronchial mucosa, and production and retention of thick/tenacious/pulmonary secretions leading to airway obstruction.
|
Asthma
|
|
|
The nurse teaches the parents of an asthmatic child the importance of:
a) pulmonary function tests b) peak flow meter tests c) CO2 retention tests d) PEEP monitoring |
b) peak flow meter tests- it will help to indicate what actions to take based on the results
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|
Which of the following is the most important action in the treatment of a child less than 5 with asthma:
a) use of a spacer b) waking the child for scheduled medications c) ensuring the parents are in the room before administration of medications d) verifying the patients name with the mother before administering medication |
a) use of a spacer
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|
What disorder involves the production of thick mucus that blocks exocrine glands and affects several body systems including respiratory, GI and reproductive.
|
cystic fibrosis
|
|
|
What electrolyte imbalance would you expect of the child with cystic fibrosis?
|
hyponatremia
|
|
|
If 2 parents have the cystic fibrosis gene, there is a __ % chance that their child will have cystic fibrosis, and a ___% chance that they will just be a carrier.
|
25% change of getting it,
50% chance of carrying it |
|
|
What would the diet concentrate on, for the patient with cystic fibrosis?
|
high protein, high calorie, high sodium, mod-fat
|
|
|
Within the first few days of birth, what might necessitate a diagnosis of CF?
|
NO passing of meconium
|
|
|
Describe the poop of the child with CF.
|
frothy, bulky, foul smelling
|
|
|
What respiratory symptoms might the child with CF present with?
|
Crackles, wheezes, diminished breath sounds, and a dry, nonproductive cough.
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|
|
A chloride concentration of greater then ___ is diagnostic of CF while a chloride concentration of greater then ___ are highly suggestive of CF.
|
60- diagnostic
40- suggestive |
|
|
Important treatment of the child with CF involves:
a) chest physiotherapy b) mucomyst administration c) serial x-ray at least every 1-2 weeks d) avoidance of antibiotics |
a) chest physiotherapy- to loosen and mobilize secretion
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|
|
In addition to encouraging a diet high in calories and protein, and taking pancreatic enzymes, what other "thing" should the child with CF take?
a) vitamins b) iron supplements c) salt supplements d) high fat food items |
a) vitamins- due to their malabsorption of fat-soluble vitamins(Vitamin A, D, E, K)
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|
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What is the primary nursing diagnosis for the child with CF?
a) high risk for infection related to impaired body defense system b) altered family processes related to frequent hospitalization c) altered growth and development related to inadequate digestion of nutrients d) ineffective airway clearance related to thickened secretions e) altered nutrition: less than body requirement related to inability to digest and/or loss of appetite |
d) ineffective airway clearance related to thickened secretions
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A patient with respiratory issues may exhibit which of the following:
a) polycythemia b) neutropenia c) high PTT d) HCT 42 |
a) polycythemia- the body increases the RBC in an attempt to increase oxygen carrying capacity
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What is a possible complication of an untreated sinus infection?
a) weakness b) meningitis c) rheumatic fever d) brain tumor |
b) meningitis
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True or False: Newborns produce a lot of mucus, it is recommended that you carry a cloth to wipe it up.
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False: newborns produce very little mucus
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When does RSV typically appear?
a) newborn b) 6 months c) 12 months d) 1-2 years old |
b) 6 months
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Discharge teaching for the child who had a tonsillectomy should include:
a) cough forcefully to disrupt mucus b) administer cough syrup c) drink lots of milk d) restrict fluids |
none of the above
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What is the first medication you should use to treat airway constriction?
a) albuterol b) aerobid(steroid) c) humidified air d) oxygen |
a) albuterol- use a fast acting bronchodilator to help open up the airways
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