231 Final exam practice questions
One hour after administering IV furosemide (Lasix) to a client with heart failure, a short burst of ventricular tachycardia appears on the cardiac monitor. Which of the following electrolyte imbalances should the nurse suspect?1.Hypocalcemia 2.Hypermagnesemia 3.Hypokalemia 4.Hypernatremia
3
Name the things that aggravates/causes an exacerbation of Multiple Sclerosis.
Anxiety Stress Fatigue Extreme hot Extreme cold Overexertion
A new graduate nurse is caring for a client undergoing hemodialysis. What assessment pair is important when it comes to the AV-fistula?
Auscultate for a bruit and palpate for a thrill
A nurse is caring for a client with unstable ventricular tachycardia. The nurse instructs the client to do which of the following, if prescribed, during an episode of ventricular tachycardia? A. Breathe deeply, regularly, and easily. B. Inhale deeply and cough forcefully every 1 to 3 seconds. C. Lie down flat in bed. D. Remove any metal jewelry.
B
A nurse is watching the cardiac monitor and notices that the rhythm suddenly changes. There are no P waves, the QRS complexes are wide, and the ventricular rate is regular but over 100. The nurse determines that the client is experiencing: A. Premature ventricular contractions B. Ventricular tachycardia C. Ventricular fibrillation D. Sinus tachycardia
B
A nurse is watching the cardiac monitor, and a client's rhythm suddenly changes. There are no P waves; instead, there are wavy lines. The QRS complexes measure 0.08 second, but they are irregular, with a rate of 120 beats a minute. The nurse interprets this rhythm as: A. Sinus tachycardia B. Atrial fibrillation C. Ventricular tachycardia D. Ventricular fibrillation
B
A nurse notes that a client with sinus rhythm has a premature ventricular contraction that falls on the T wave of the preceding beat. The client's rhythm suddenly changes to one with no P waves or definable QRS complexes. Instead, there are coarse wavy lines of varying amplitude. The nurse assesses this rhythm to be: A. Ventricular tachycardia B. Ventricular fibrillation C. Atrial fibrillation D. Asystole
B
What is the ultimate goal of treatment for Parkinson disease?
Keeping the client as independent as possible for as long as possible.
Provide the correct heart rate range for sinus bradycardia
Less than 60 bpm
Name this complication of a radical mastectomy:
Lymphedema
A client on peritoneal dialysis is receiving education regarding diet and nutrition. Name a dietary protein that would be recommended for this patient.
Meat Poultry Fish Eggs
The nurse is providing care to a client that is HIV-Positive. IF the nurse suffers an accidental needlestick, what is the FIRST action the nurse should take and what time frame does the CDC recommend for this action?
Thoroughly scrub and flush the needlestick site. The CDC recommends for 1 full minute.
What is the name of the test that examines cardiac structure and function with an ultrasound transducer placed immediately behind the heart in the esophagus or stomach?
Transesophageal echocardiogram (TEE)
What is the FIRST action by the nurse when the client is displaying signs/symptoms of autonomic dysreflexia and what other interventions should the nurse perform next?
The FIRST action is to sit the patient up. The secondary interventions is to remove noxious stimuli, administer calcium channel blockers like nifedipine (procardial), alpha-adrenergic blocker like prazosin (minipress) and clonidine (catapres), or a nitrite like nitroglycerin (nitrostat)
What is the appropriate medical term for the tell-tale skin manifestation for a client with systemic lupus erythematosus?
Erythematous rash (butterfly rash)
Provide the correct heart rate range for sinus tachycardia.
100-160
What is the GCS score range for a client with a mild traumatic brain injury?
13-15
What is the GCS score range for a client with a severe traumatic brain injury?
3-8
A client admitted after using crack cocaine develops ventricular fibrillation. After determining unresponsiveness, which action should the nurse take next? a. Defibrillate at 200 J. b. Establish IV access. c. Place an oral airway and ventilate. d. Start cardiopulmonary resuscitation (CPR).
A Defibrillating is of priority before any other resuscitative measures according to Advanced Cardiac Life Support protocols.
Provide the correct heart rate range for normal sinus rhythm
60-100
What is the GCS score range for a client with a moderate traumatic brain injury?
9-12
A client has developed atrial fibrillation, which has a ventricular rate of 150 beats per minute. A nurse assesses the client for: A. Hypotension and dizziness B. Nausea and vomiting C. Hypertension and headache D. Flat neck veins
A
A client is having frequent premature ventricular contractions. A nurse would place a priority on the assessment of which of the following items? A. Blood pressure and peripheral perfusion. B. Sensation of palpitations. C. Causative factors such as caffeine. D. Precipitating factors such as infection.
A
A client with rapid rate atrial fibrillation asks a nurse why the physician is going to perform carotid massage. The nurse responds that this procedure may stimulate the: A. Vagus nerve to slow the heart rate. B. Vagus nerve to increase the heart rate; overdriving the rhythm. C. Diaphragmatic nerve to slow the heart rate. D. Diaphragmatic nerve to overdrive the rhythm.
A
A client's electrocardiogram strip shows atrial and ventricular rates of 80 complexes per minute. The PR interval is 0.14 second, and the QRS complex measures 0.08 second. The nurse interprets this rhythm is: A) Normal sinus rhythm B) Sinus bradycardia C) Sinus tachycardia D) Sinus dysrhythmia
A
A nurse is assessing an electrocardiogram rhythm strip. The P waves and QRS complexes are regular. The PR interval is 0.16 second, and QRS complexes measure 0.06 second. The overall heart rate is 64 beats per minute. The nurse assesses the cardiac rhythm as: A. Normal sinus rhythm B. Sinus bradycardia C. Sick sinus syndrome D. First-degree heart block
A
A patient in asystole is likely to receive which of the following drug treatments? a. Atropine and epinephrine b. Lidocaine and amiodarone c. Digoxin and procainamide d. β-Adrenergic blockers and dopamine
A
The nurse is caring for a client with atrial fibrillation. In addition to an antidysrhythmic, what medication does the nurse plan to administer? a. Heparin b. Atropine c. Dobutamine d. Magnesium sulfate
A Clients with atrial fibrillation are prone to blood pooling in the atrium, clotting, then embolizing. Heparin is used to prevent thrombus development in the atrium and the consequence of embolization (i.e., stroke).
The nurse is caring for a client with advanced heart failure who develops asystole. The nurse corrects the new graduate when the graduate offers to perform which intervention? a. Defibrillation b. Cardiopulmonary resuscitation (CPR) c. Administration of atropine d. Administration of oxygen
A Defibrillation interrupts the heart rhythm and allows normal pacemaker cells to take over: in asystole, there is no rhythm to interrupt; therefore this intervention is not used.
A 20-year-old has a mandatory electrocardiogram (ECG) before participating on a college soccer team and is found to have sinus bradycardia, rate 52. Blood pressure (BP) is 114/54, and the student denies any health problems. What action by the nurse is most appropriate? a.Allow the student to participate on the soccer team. b.Refer the student to a cardiologist for further diagnostic testing. c.Tell the student to stop playing immediately if any dyspnea occurs. d.Obtain more detailed information about the student's family health history.
A In an aerobically trained individual, sinus bradycardia is normal. The student's normal BP and negative health history indicate that there is no need for a cardiology referral or for more detailed information about the family's health history. Dyspnea during an aerobic activity such as soccer is normal.
You are the charge nurse on the telemetry unit and are responsible for making client assignments. Which client would be appropriate to assign to the float RN from the medical-surgical unit? a. The 64-year-old admitted for weakness who has a first-degree heart block with a heart rate of 58 beats/min b. The 71-year-old admitted for heart failure who is short of breath and has a heart rate of 120 to 130 beats/min c. The 88-year-old admitted with an elevated troponin level who is hypotensive with a heart rate of 96 beats/min d. The 92-year-old admitted with chest pain who has premature ventricular complexes and a heart rate of 102 beats/min
A This client has a stable, asymptomatic dysrhythmia, which usually requires no treatment; this client can be managed by a nurse with less cardiac dysrhythmia training.
For which of the following dysrhythmias is defibrillation primarily indicated? a. Ventricular fibrillation b. Third-degree AV block c. Uncontrolled atrial fibrillation d. Ventricular tachycardia with a pulse
A Defibrillation is always indicated in the treatment of ventricular fibrillation. Drug treatments are normally used in the treatment of uncontrolled atrial fibrillation and for ventricular tachycardia with a pulse (if the patient is stable). Otherwise, synchronized cardioversion is used (as long as the patient has a pulse). Pacemakers are the treatment of choice for third-degree heart block.
What criteria should the nurse use to determine normal sinus rhythm for a client on a cardiac monitor? Select all that apply. A. The RR intervals are relatively consistent. B. One P wave precedes each QRS complex. C. Four to eight complexes occur in a 6-second strip. D. The ST segment is higher than the PR interval. E. The QRS complex ranges from 0.12 to 0.20 second.
AB
What is the PRIORITY assessment for a patient with any cervical spine injury?
ABC's (airway, breathing, circulation)
What is the priority assessment for a client with ventricular tachycardia?
ABC's (airway, breathing, circulation)
What is the priority nursing assessment for a client with a traumatic brain injury?
ABC's (airway, breathing, circulation)
The nurse is caring for a client who has developed a bradycardia. Which possible causes should the nurse investigate? Select all that apply a. Bearing down for a bowel movement b. Possible inferior wall myocardial infarction (MI) c. Client stating that he just had a cup of coffee d. Client becoming emotional when visitors arrived e. Diltiazem (Cardizem) administered an hour ago
ABE The Valsalva maneuver stimulates the vagus nerve, causing bradycardia. Inferior wall MI is a cause of bradycardia and heart blocks. Calcium channel blockers such as diltiazem may cause bradycardia.
A nurse notices frequent artifacts on the ECG monitor for a client whose leads are connected by cable to a console at the bedside. The nurse examines the client to determine the cause. Which of the following items is unlikely to be responsible for the artifact? A. Frequent movement of the client. B. Tightly secured cable connections. C. Leads applied over hairy areas. D. Leads applied to the limbs.
B
Atherosclerosis impedes coronary blood flow by which of the following mechanisms? A. Plaques obstruct the vein. B. Plaques obstruct the artery. C. Blood clots form outside the vessel wall. D. Hardened vessels dilate to allow blood to flow through.
B
The nurse is caring for a client with unstable angina whose cardiac monitor shows ventricular tachycardia. Which action is appropriate to implement first? a. Defibrillate using 200 J. b. Check the client for a pulse. c. Cardiovert the client at 50 J. d. Administer IV ibutilide (Corvert).
B
The nurse is watching the cardiac monitor, and a patient's rhythm suddenly changes. There are no P waves. Instead there are fine, wavy lines between the QRS complexes. The QRS complexes measure 0.08 sec (narrow), but they occur irregularly with a rate of 120 beats/min. The nurse correctly interprets that this rhythm is which of the following? a. Sinus tachycardia b. Atrial fibrillation c. Ventricular fibrillation d. Ventricular tachycardia
B
When ventricular fibrillation occurs in a CCU, the first person reaching the client should: A. Administer oxygen. B. Defibrillate the client. C. Initiate CPR. D. Administer sodium bicarbonate intravenously.
B
While caring for a client who has sustained an MI, the nurse notes eight PVCs in one minute on the cardiac monitor. The client is receiving an IV infusion of D5W and oxygen at 2 L/minute. The nurse's first course of action should be to: A. Increase the IV infusion rate. B. Notify the physician promptly. C. Increase the oxygen concentration. D. Administer a prescribed analgesic.
B
A nurse is assessing clients on a medical-surgical unit. Which client should the nurse identify as being at greatest risk for atrial fibrillation? a. A 45-year-old who takes an aspirin daily b. A 50-year-old who is post coronary artery bypass graft surgery c. A 78-year-old who had a carotid endarterectomy d. An 80-year-old with chronic obstructive pulmonary disease
B Atrial fibrillation occurs commonly in clients with cardiac disease and is a common occurrence after coronary artery bypass graft surgery. The other conditions do not place these clients at higher risk for atrial fibrillation.
A nurse evaluates prescriptions for a client with chronic atrial fibrillation. Which medication should the nurse expect to find on this client's medication administration record to prevent a common complication of this condition? a. Sotalol (Betapace) b. Warfarin (Coumadin) c. Atropine (Sal-Tropine) d. Lidocaine (Xylocaine)
B Atrial fibrillation puts clients at risk for developing emboli. Clients at risk for emboli are treated with anticoagulants, such as heparin, enoxaparin, or warfarin. Sotalol, atropine, and lidocaine are not appropriate for this complication.
A nurse cares for a client with an intravenous temporary pacemaker for bradycardia. The nurse observes the presence of a pacing spike but no QRS complex on the client's electrocardiogram. Which action should the nurse take next? a. Administer intravenous diltiazem (Cardizem). b. Assess vital signs and level of consciousness. c. Administer sublingual nitroglycerin. d. Assess capillary refill and temperature
B In temporary pacing, the wires are threaded onto the epicardial surface of the heart and exit through the chest wall. The pacemaker spike should be followed immediately by a QRS complex. Pacing spikes seen without subsequent QRS complexes imply loss of capture. If there is no capture, then there is no ventricular depolarization and contraction. The nurse should assess for cardiac output via vital signs and level of consciousness. The other interventions would not determine if the client is tolerating the loss of capture.
A patient whose heart monitor shows sinus tachycardia, rate 132, is apneic and has no palpable pulses. What is the first action that the nurse should take? a.Perform synchronized cardioversion. b.Start cardiopulmonary resuscitation (CPR). c.Administer atropine per agency dysrhythmia protocol. d.Provide supplemental oxygen via non-rebreather mask.
B The patient's clinical manifestations indicate pulseless electrical activity and the nurse should immediately start CPR. The other actions would not be of benefit to this patient.
The nurse is caring for a client with acute coronary syndrome (ACS) and atrial fibrillation who has a new prescription for metoprolol (Lopressor). Which monitoring is essential when administering the medication? a. ST segment b. Heart rate c. Troponin d. Myoglobin
B The effects of metoprolol are to decrease heart rate, blood pressure, and myocardial oxygen demand. ST segment elevation is consistent with MI; it does not address monitoring of metoprolol. Elevation in troponin is consistent with a diagnosis of MI but does not address needed monitoring for metoprolol. Elevation in myoglobin is consistent with myocardial injury in ACS but does not address needed monitoring related to metoprolol.
The nurse is caring for a client with unstable angina whose cardiac monitor shows ventricular tachycardia. Which action is appropriate to implement first? a. Defibrillate the client at 200 J. b. Check the client for a pulse. c. Cardiovert the client at 50 J. d. Give the client IV lidocaine.
B The nurse needs to assess the client to determine stability before proceeding with further interventions. If the client has a pulse and is relatively stable, elective cardioversion or antidysrhythmic medications may be prescribed.
The nurse teaches a client with new-onset atrial fibrillation that risk factors for this dysrhythmia may include which? Select all that apply. a. Use of beta-adrenergic blockers b. Excessive alcohol use c. Advancing aged. High blood pressure e. Palpitations
BCD
The nurse administers amiodarone (Cordarone) to a client with ventricular tachycardia. Which monitoring by the nurse is necessary with this drug? Select all that apply. a. Respiratory rate b. QT interval c. Heart rate and rhythm d. Magnesium level e. Urine output
BCD Amiodarone causes prolongation of the QT interval, which can precipitate dysrhythmia. Antidysrhythmic medications cause changes in cardiac rhythm and rate; therefore monitoring of heart rate and rhythm is needed.Electrolyte depletion, specifically potassium and magnesium, may predispose to further dysrhythmia. Although it is always important to monitor vital signs and urine output, these assessments are not specific to amiodarone.
What are examples of valsalva maneuver (give 2 examples)?
Bear down like trying to have a bowel movement Exhaling to imitate trying to blow up a balloon.
How is hepatitis C transmitted?
Blood to Blood
A client with atrial fibrillation with rapid ventricular response has received medication to slow the ventricular rate. The pulse is now 88. For which additional therapy does the nurse plan? a. Synchronized cardioversion b. Electrophysiology studies (EPS) c. Anticoagulation d. Radiofrequency ablation therapy
C
A nurse is viewing the cardiac monitor in a client's room and notes that the client has just gone into ventricular tachycardia. The client is awake and alert and has good skin color. The nurse would prepare to do which of the following? A. Immediately defibrillate. B. Prepare for pacemaker insertion. C. Administer amiodarone (Cordarone) intravenously. D. Administ
C
What teaching does the nurse include for a client with atrial fibrillation who has a new prescription for warfarin? a. It is important to consume a diet high in green leafy vegetables. b. You should take aspirin or ibuprofen for headache. c. Report nosebleeds to your provider immediately. d. Avoid caffeinated beverages.
C
When auscultating the apical pulse of a client who has atrial fibrillation, the nurse would expect to hear a rhythm that is characterized by: A. The presence of occasional coupled beats. B. Long pauses in an otherwise regular rhythm. C. A continuous and totally unpredictable irregularity. D. Slow but strong and regular beats.
C
A patient who is on the progressive care unit develops atrial flutter, rate 150, with associated dyspnea and chest pain. Which action that is included in the hospital dysrhythmia protocol should the nurse do first?a.Obtain a 12-lead electrocardiogram (ECG). b.Notify the health care provider of the change in rhythm. c.Give supplemental O2 at 2 to 3 L/min via nasal cannula. d.Assess the patient's vital signs including oxygen saturation.
C Because this patient has dyspnea and chest pain in association with the new rhythm, the nurse's initial actions should be to address the patient's airway, breathing, and circulation (ABC) by starting with oxygen administration. The other actions also are important and should be implemented rapidly.
The nurse asks a client who has experienced ventricular dysrhythmias about substance abuse. The client asks, "Why do you want to know if I use cocaine?" How should the nurse respond? a. "Substance abuse puts clients at risk for many health issues." b. "The hospital requires that I ask you about cocaine use." c. "Clients who use cocaine are at risk for fatal dysrhythmias." d. "We can provide services for cessation of substance abuse."
C Clients who use cocaine or illicit inhalants are particularly at risk for potentially fatal dysrhythmias. The other responses do not adequately address the client's question.
Which of the following ECG characteristics is consistent with a diagnosis of ventricular tachycardia (VT)? a. Unmeasurable rate and rhythm b. Rate 150 beats/min; inverted P wave c. Rate 200 beats/min; P wave not visible d. Rate 125 beats/min; normal QRS complex
C VT is associated with a rate of 150 to 250 beats/min; the P wave is not normally visible. P wave inversion and a normal QRS complex are not associated with VT. Rate and rhythm are not measurable in ventricular fibrillation.
Name 3 risks for atrial fibrillation
CAD MI Valvular heart disease HTN Lung disease Stress Previous heart surgery Sleep apnea Thyroid disease Use of stimulants (meds, caffeine, tobacco, alcohol) Viral diseases Obesity Genetics
What is the priority action by caregivers for asystole?
CPR
What are assessments for bradycardia?
Cardiac monitoring Blood Pressure/HR LOC Apical Pulse/Auscultation Cap refill
When creating a plan of care for the dying client, what are the desired outcomes for the client?
Controlling or managing symptoms of distress, controlling or managing pain, meaningful interactions with family and other loved ones, a peaceful-death
A paradoxical pulse occurs in a client who had a coronary artery bypass graft (CABG) surgery two (2) days ago. Which of the following surgical complications should the nurse suspect? A. Left-sided heart failure B. Aortic regurgitation C. Complete heart block D. Pericardial tamponade
D
In teaching clients at risk for bradydysrhythmias, what information does the nurse include? a. "Avoid potassium-containing foods." b. "Stop smoking and avoid caffeine." c. "Take nitroglycerin for a slow heartbeat." d. "Use a stool softener."
D Clients at risk for bradydysrhythmias should avoid bearing down or straining during a bowel movement; the Valsalva maneuver can cause bradycardia. Taking a stool softener helps to prevent this.
A client with atrial fibrillation is receiving digoxin (Lanoxin). It is MOST important for the nurse to? a. Record an EKG strip after administration b. Monitor blood pressure every 4 hours c. Maintain accurate intake and output records d. Measure apical pulse prior to administration
D Digitoxin decreases conduction velocity through the AV node and prolongs the refractory period. If the apical heart rate is less than 60 beats/minute, withhold the drug. The apical pulse should be taken with a stethoscope so that there will be no mistake about what the heart rate actually is.
How does the nurse recognize that atropine has produced a positive outcome for the client with bradycardia? a. Client states he is dizzy and weak. b. The nurse notes dyspnea. c. The client has a heart rate of 42. d. The monitor shows sinus rhythm.
D Sinus rhythm presents with heart rates from 60 to 100 beats/min; by definition, the bradydysrhythmia has resolved.
The nurse obtains a rhythm strip on a patient who has had a myocardial infarction and makes the following analysis: no visible P waves, P-R interval not measurable, ventricular rate 162, R-R interval regular, and QRS complex wide and distorted, QRS duration 0.18 second. The nurse interprets the patient's cardiac rhythm as a.atrial flutter. b.sinus tachycardia. c.ventricular fibrillation. d.ventricular tachycardia.
D The absence of P waves, wide QRS, rate >150 beats/minute, and the regularity of the rhythm indicate ventricular tachycardia. Atrial flutter is usually regular, has a narrow QRS configuration, and has flutter waves present representing atrial activity. Sinus tachycardia has P waves. Ventricular fibrillation is irregular and does not have a consistent QRS duration.
A patient who was admitted with a myocardial infarction experiences a 45-second episode of ventricular tachycardia, then converts to sinus rhythm with a heart rate of 98 beats/minute. Which of the following actions should the nurse take next? a.Immediately notify the health care provider. b.Document the rhythm and continue to monitor the patient. c.Perform synchronized cardioversion per agency dysrhythmia protocol. d.Prepare to give IV amiodarone (Cordarone) per agency dysrhythmia protocol.
D The burst of sustained ventricular tachycardia indicates that the patient has significant ventricular irritability, and antidysrhythmic medication administration is needed to prevent further episodes. The nurse should notify the health care provider after the medication is started. Defibrillation is not indicated given that the patient is currently in a sinus rhythm. Documentation and continued monitoring are not adequate responses to this situation.
A nurse prepares to defibrillate a client who is in ventricular fibrillation. Which priority intervention should the nurse perform prior to defibrillating this client? a. Make sure the defibrillator is set to the synchronous mode. b. Administer 1 mg of intravenous epinephrine. c. Test the equipment by delivering a smaller shock at 100 joules. d. Ensure that everyone is clear of contact with the client and the bed.
D To avoid injury, the rescuer commands that all personnel clear contact with the client or the bed and ensures their compliance before delivery of the shock. A precordial thump can be delivered when no defibrillator is available. Defibrillation is done in asynchronous mode. Equipment should not be tested before a client is defibrillated because this is an emergency procedure; equipment should be checked on a routine basis. Epinephrine should be administered after defibrillation.
A client has frequent bursts of ventricular tachycardia on the cardiac monitor. A nurse is most concerned with this dysrhythmia because: A) It is uncomfortable for the client, giving a sense of impending doom. B) It produces a high cardiac output that quickly leads to cerebral and myocardial ischemia. C) It is almost impossible to convert to a normal sinus rhythm. D) It can develop into ventricular fibrillation at any time.
D Ventricular tachycardia is a life-threatening dysrhythmia that results from an irritable ectopic focus that takes over as the pacemaker for the heart. The low cardiac output that results can lead quickly to cerebral and myocardial ischemia. Client's frequently experience a feeling of impending death. Ventricular tachycardia is treated with antidysrhythmic medications or magnesium sulfate, cardioversion (client awake), or defibrillation (loss of consciousness), Ventricular tachycardia can deteriorate into ventricular defibrillation at any time.
What is the priority action by caregivers for ventricular fibrillation?
Defibrillation followed by Amiodarone with 5 rounds of CPR until normal rhythm is restored
Which neurotransmitter contributes to the impaired balance and uncontrolled tremors in a client that has Parkinson disease.
Dopamine
What are the blood pressure measurements that indicate orthostatic hypotension is present?
Drop in blood pressure 20 mm Hg or more systolically or 10 mm Hs or more diastolically
What type of stroke are patients with atrial fibrillation at risk for?
Embolic stroke
True or False: A blood pressure measurement can be taken in the same arm as an AV fistula or graft.
False
Name the triad of symptoms in females likely experiencing a heart attack.
Fatigue SOB Indigestion
What is the name of the tool that is used to facilitate an assessment to determine a client's level of consciousness?
GCS
What are the risk factors for breast cancer? Separate them into modifiable and nonmodifiable.
Modifiable Obesity (postmenopausal) Physical inactivity Hormone replacement therapy Alcohol consumption Lack of breastfeeding Smoking Nonmodifiable Female Age (65+) Genetic factors Family history Previous history of breast cancer Early menarche Late menopause Nulliparity (women who hasn't given birth) Increased breast density
What narcotic is used for the relief of pain, dyspnea, and anxiety at the end of life?
Morphine
Name an appropriate location to assess capillary refill.
Nail Beds, either fingernails or toenails
What is the name of the tool that is used to facilitate a focussed neurological assessment on a stroke patient?
National Institutes of Health Stroke Scale (NIHS)
What is the drug of choice for the treatment of autonomic dysreflexia and what complication are we trying to prevent?
Nifedipine (Procardia) and we are trying to prevent a hypertensive stroke
What is the medical term for involuntary, rhythmic eye movements?
Nystagmus
Which part of the heart is known as the pacemaker?
SA node
What are complications (signs and symptoms) of sinus tachycardia that need immediate attention?
SOB Syncope Decreased cardiac output Chest pain
What are identifying features of atrial flutter?
Sawtooth waves on baseline
Name at least 3-5 causes/risk factors for a stroke.
Smoking Obesity Hypertension Hypercholesterol Genetics Drugs Alcohol Oral contraceptive use by females
What does staff need to do in order to defibrillate safely?
Stand clear. No one touches the patient.
What type of precautions should be used when caring for a patient with HIV?
Standard precautions
What to avoid to prevent atrial fibrillation?
Stimulants (caffeine, alcohol, tobacco, meds) Processed Foods Salt
Name at least 3 clinical manifestations of autonomic dysreflexia.
Sudden and severe hypertension Goose bumps above and below the injury level Nasal congestion Blurred vision Severe throbbing headache Facial and skin flushing Profuse sweating about the injury level
What are the signs and symptoms of autonomic dysreflexia?
Sudden and severe hypertension Goose bumps above and below the injury level Nasal congestion Blurred vision Severe throbbing headache Facial and skin flushing Profuse sweating about the injury level
True or False: It is appropriate for the client to wear oxygen via nasal cannula during cardioversion.
false
How is Hepatitis A transmitted?
fecal-oral
Is it ok to apply electrodes on top of hair?
no
Name for tests that make up lipid panel when testing for atherosclerosis
total cholesterol LDL HDL triglycerides
True or False: Individuals who use illicit drugs or inhalants are at risk for potentially fatal dysrhythmias.
true
True or False: The hypotensive Client who had a heart attack will be tachycardic.
true