Medsurg 2 Exam 2 Add ons

A. Continue to monitor the client.

A client is in a sinus rhythm with an occasional premature atrial contraction (PAC). Which action would the nurse A. Continue to monitor the client. B. Activate the Rapid Response Team. C. Ensure that a defibrillator is available close by. D. Give lidocaine intravenously as per protocol.

A. Perform a head-to-toe assessment.

A heart failure patient on daily weights has a 4-pound weight gain since yesterday, which action would the nurse take A. Perform a head-to-toe assessment. B. Place the client on restricted fluid intake. C. Discuss a restricted sodium diet with the client. D. Document the findings in the health care record.

sinus bradycardia

A well trained athlete may have this

a. now; less; 48 hours b. greater; 48 hours; anticoagulants; cardioversion

Atrial fibrillation and atrial flutter: a. _ or _ than _ _: DO _ STAT b. _ than _ _ : Give _ and then do _

anticoagulants (and then cardioversion)

Atrial fibrillation and atrial flutter: If the onset is greater than 48 hours, do what?

cardioversion

Atrial fibrillation and atrial flutter: If the onset is now or less than 48 hours, do what?

1. now 2. less than 48 hours

Atrial fibrillation and atrial flutter: If the patient onset is what, do cardioversion? (2)

no

Atrial fibrillation and atrial flutter: Should you do cardioversion for a fib or a flutter if you do not know the onset?

onset

Atrial fibrillation and atrial flutter: The most important thing to find out is the _

automaticity

Cardiac cells generate spontaneous action potentials

conductivity

Concerns SA and AV nodes

excitability

Concerns impulses

C. Atropine sulfate

During a procedure, the client's heart rate drops to 38 beats/min. Which medication is indicated to treat bradycardia? A. Digoxin B. Amiodarone C. Atropine sulfate D. Lidocaine

excitability

Ease of cardiac cells to depolarize/repolarize

contractility

Eject stroke volume

assess if the patient is symptomatic

Heart block treatment do what first?

asystole; cpr

If the patient has no pulse, treat it as _ and start _

Asystole

If the patient has no pulse, treat this as what?

1. call the hcp 2. monitor

If you see PVCs, do what?

conductivity

Impulses travel. Cause heart to beat. SA/AV nodes

1. atrial fibrillation 2. atrial flutter

Onset is important for what 2 rhythms?

electrolytes

Positive/negative electrical charge when dissolved in water.

1. Vagal maneuver 2. Adenosine 3. cardioversion

SVT: In what order to do you treatments?

pericarditis and endocarditis

Sharp knifelike pain with breathing is in what condition?

PR interval

Sinus rhythm: Make sure to assess the _ _

D. Amiodarone

The cardiac monitor reveals several runs of ventricular tachycardia. Which medication is used to treat this dysrhythmia? A. Atropine B. Sodium bicarbonate C. Epinephrine D. Amiodarone

B. Paroxysmal supraventricular tachycardia (PSVT)

The monitor shows sudden bursts of a regular rhythm with a rate of 220 BpM, normal QRS, and no P waves, the rhythm is A. Atrial fibrillation B. Paroxysmal supraventricular tachycardia (PSVT) C. NSR D. Ventricular fibrillation

Lead fell off/ekg problem

V fib: If the patient is alert and responsive, what is thr problem?

assess the patient

V fib: What should you do before interventions?

defibrillation

V fib: if you check the patient and they have loss of consciousness, do what?

4. SUSTAINED 5. blood pressure 6. Amiodarone 7. cardioversion

V tach: 1. Ventricular tachycardia: Hallmark: Regular, fast rhythm with WIDE INVERTED QRS 2. Call doc 3. Prepare the defibrillator/cardioversion before patient goes into v fib 4. DO NOT USE defibrillator or cardioversion until it becomes _ 5. IF YOU SEE V TACH, THE FIRST THING YOU NEED TO DO IS assess THE PATIENT'S _ _ , PULSE, and CONSCIOUSNESS. BC TREATMENT IS RELATED TO BP! 6. Normal Blood pressure: _ 7. Low BP: _ 8. Using meds is better than shocking!

sustained

V tach: Do not use the cardioversion until it becomes what?

amiodarone

V tach: IF you have a normal BP, do what?

cardioversion

V tach: If you have a Decreased BP, do what?

check the BP

V tach: If you see v tach, what is the first thing you need to do?

1. assess; patient 2. ekg; lead a. do not; defibrillator 3. loss; consciousness; defibrillation 4. defibrillator

Ventricular fibrillation: Smooth or rough half circles. Fast up and down (some cardiac output) 1. _ the _ to see if they are responsive before interventions! (This can occur if a lead fell off, which is why you need to check first) 2. If the patient is alert, oriented, and responsive: This is a problem with the _ machine/_ problem. a. _ _ use the _ 3. If you check and patient not responsive/_ OF _=Initiate _! 4. * if you are at the nurse's station and you see v fib, take the _

tall peaked t wave; check potassium

What is a sign of hyperkalemia? What should you do if you see a tall peaked t wave?

onset

What is most important about atrial flutter and atrial fibrillation?

C. Assess client pulse and blood pressure.

When a client in the coronary care unit develops ventricular tachycardia, which action will the nurse take first? A. Initiate immediate defibrillation. B. Perform synchronized cardioversion. C. Assess client pulse and blood pressure. D. Start cardiopulmonary resuscitation (CPR).

B. Sinus tachycardia

When a client's monitor shows a PQRST wave for each beat, with a regular rhythm and a rate of 120 BPM, the rhythm is A. Atrial fibrillation B. Sinus tachycardia C. NSR D. Ventricular fibrillation

A. P waves

When the nurse needs to determine atrial rate and rhythm, which component of the electrocardiogram will be used? A. P waves B. PR intervals C. T waves D. QRS complexes

C. Fourth intercostal space, right sternal border

Where will the nurse place the V1 lead when obtaining a 12- lead electrocardiogram? A. Fifth intercostal space, left midaxillary line B. Second intercostal space, left sternal border C. Fourth intercostal space, right sternal border D. Fifth intercostal space, left midclavicular line

B. Walking outside on a cold day

Which activities might cause chest pain in a client with stable angina? A. Deep breathing during meditation B. Walking outside on a cold day C. Taking an afternoon nap D. Using nitroglycerin patch

A. Low cardiac output

Which adverse hemodynamic effects typically occur when a client develops tachycardia? A. Low cardiac output B. Increase ventricular filling time C. Increase cardiac output D. Strong pulse quality

C. Peripheral edema

Which assessment finding is a late sign of heart failure? A. Tachypnea B. Tachycardia C. Peripheral edema D. Periorbital edema

A. Distended abdomen

Which assessment findings are consistent with a client diagnosis of right-sided heart failure? A. Distended abdomen B. Cool extremities C. Collapsed neck veins D. Good appetite

C. Apical heart rate

Which assessment will the nurse conduct before administering digoxin to a client? A. Radial pulse B. Difference between carotid and radial pulses C. Apical heart rate D. Difference between apical and radial pulses

A. Client with chest pressure and ST elevation on the electrocardiogram

Which client in the emergency department would the nurse assess first? A. Client with chest pressure and ST elevation on the electrocardiogram B. Client with a sharp chest pain with deep inspiration for the past week C. Client who has history of HF with ascites and 4+ ankle swelling D. Client with atrial fibrillation at a rate of 136 beats/minute

D. Chronic obstructive pulmonary disease (COPD)

Which condition unrelated to cardiac disease is the major cause of right ventricular failure? A. Hypovolemic shock B. Chronic kidney disease C. Systemic inflammatory response syndrome (SIRS) D. Chronic obstructive pulmonary disease (COPD)

D. Continues after rest and nitroglycerin

Which finding about a client's angina is most important for the nurse to communicate to the health care provider? A. Causes mild perspiration B. Precipitates discomfort in the arms and jaw C. Occurs after moderate exercise D. Continues after rest and nitroglycerin

B. Sudden vision change

Which finding for a client with new-onset atrial fibrillation would be most important to communicate to the HCP? A. Irregular apical pulse B. Sudden vision change C. Exertional dyspnea D. Lower extremity edema

left

Which heart failure requires a mental status assessment

B. Calcium channel blockers

Which medication prescribed for a client with an acute episode of heart failure would the nurse question? A. Diuretic B. Calcium channel blockers C. Long-acting nitrate D. Angiotensin receptor blocker

D. Relieved by sublingual nitroglycerin

Which pain characteristic would the nurse expect to observe when a client is experiencing anginal pain? A. Unchanged by rest B. Precipitated by light activity C. Described as a knifelike sharpness D. Relieved by sublingual nitroglycerin

A. Fluid volume

Which parameter would the nurse assess in a client with right-sided heart failure? A. Fluid volume B. Mental status C. Respiratory rate D. SPO2

B. 'I wake up at night short of breath.'

Which statement by a client in the HF clinic is most important for the nurse to communicate to the healthcare provider? A. 'I am unable to run 1 mile (1.6 km) now.' B. 'I wake up at night short of breath.' C. 'My spouse says I snore loudly.' D. 'My shoes seem larger lately.'

B. "I have trouble breathing when I climb a flight of stairs.'

Which statement by a client is consistent with a diagnosis of Heart Failure ? A. 'I feel bloated when I eat a large meal.' B. "I have trouble breathing when I climb a flight of stairs.' C. 'I see spots before my eyes.' D. 'I am tired at the end of the day.'