NUR 211: EXAM 1

what pulse changes would you expect to see in a patient with hypovolemic shock?

- HR increase - pulse pressure narrows - weak, feeble peripheral pulse

What does norepinephrine do?

- peripheral vasoconstrictor - elevates BP and CO in patients suffering from anaphylactic reactions

What lab result will help the nurse determine whether a client is recieving a therapeutic dose of IV heparin?

APTT (PTT is 70 seconds)

What part of the ECG represents early ventricular repolarization?

ST segment

What is myoglobin?

a marker that increases after an MI, but it lacks cardiac specificity

what heart rhythm would be described as an irregularly irregular rhythm?

a-fib

What is the amount of time in which irreversible hypoxic brain injury occurs?

after 4 minutes

Why is a beta blocker contraindicated in a patient with an acute episode of heart failure?

beta blockers -- they reduce CO and are contraindicated with acute HF although they will be prescribed in patients with CHF to prevent the progression

What do PT and PTT tests assess for?

blood coagulation

What is the purpose of a low-sodium diet for clients with HF?

decrease fluid retention

are distant heart sounds associated with hypo- or hyper- thyroidism?

hypothyroidism

What should be assessed in a patient with a cardiac history complaining of weight gain despite nausea and anorexia?

presence of a cough and exertional dyspnea

What does ANP do?

produced by the right atrium of the heart in response to increased blood volume. it acts on the kidneys to promote Na excretion which decreased the blood volume

Which compensatory changes occur in the C/V system during pregnancy?

- Increased blood volume - Increased cardiac output - enlargement of the heart

What ECG changes might you see in a patient with hypokalemia?

- Inverted T wave - ST depression - Prominent U wave

What findings are associated with L-sided- HF?

- JV collapse - oliguria

JVD is a specific sign of what type of HF? How is it treated?

- right sided - diuretics

What lab values are used to indicate therapeutic levels of warfarin?

INR and PT

How is CVAD placement verified?

X-ray -- they are radiopaque

What is a unifocal PVC?

a PVC that occurs in no particular pattern and looks like all other PVCs

What does a UO of 15 mL/hr in a patient admitted with an MI indicate?

a low UO may indicate left ventricular failure. HF is a common complication of patients following a MI.

What does the P-wave represent?

atrial depolarization/ contraction in response to the SA node

What indications of spinal shock would the nurse monitor for in the ED with possible spinal cord injury?

bradycardia, hypotension, and urinary retention

What are CK levels?

cardiac enzymes that increase with myocardial necrosis within 3-6 hours but are not as sensitive as troponin testing for acute myocardial necrosis

What do alpha-adrenergic blockers do?

decrease peripheral resistance, resulting in a decreased blood pressure

what is the FIRST action to take after determining a rhythm to be v fib?

defib

What abnormal lab results can be expected in a patient that is on lithium therapy?

elevated WBC count

why does clubbing of fingernails indicate?

hypoxemia

When caring for a patient in late hypovolemic shock, which complication will the nurse anticipate?

metabolic acidosis -- decreased cellular O2 caused by poor perfusion increases the conversion of pyruvic acid to lactic acid

What would you expect to assess in a patient with varicose veins?

- ankle edema - increased leg fatigue - report of leg fullness and pruritus

A patient has been admitted with an ACS to the telemetry unit after cardiac cath and PCI. What would be the most important thing for the nurse to do?

- attach the cardiac monitor

What is the therapeutic lithium level?

0.6-1.2

what will be seen in a patient with cor pulmonae?

clinical manifestations of heart failure like JVD, peripherial edema, hepatomegaly with right upper quadrant tenderness and elevated BNP due to atrial enlargement, polycythemia with increases in hgb and hct and increased blood viscosity

A patient with a hx of HF reports a 4 pound weight gain since the previous day. What actions should the nurse take?

first perform a head-to-toe assessment, then determine if fluid restriction and salt restriction should be initiated

What discharge teaching should be given to a patient leaving with a prescription for warfarin?

- avoid ASA and NSAIDs because it interferes with platelet aggregation. - acetaminophen should be used when an analgesic is required because it does not interfere with platelet aggregation

What education should the nurse give to a patient who had a recent mitral valve replacement in regards to exercising?

- avoid strenuous exercise initially because the heart may initially be unable to accommodate the associated increase in CO.

What are the terms for PVCs that occur in patterns?

- bigeminal: evey other beat - trigeminal: every third beat - couplet: two consecutive

What type of medication would you anticipate administering in a patient with cardiogenic shock and an increased pulmonary wedge pressure?

- loop diuretic to decrease ventricular preload

What do cardiac glycoside drugs do?

- slow and strengthen the heartbeat - may decrease the BP

What teaching should be provided when discharging a patient with CAD about aspirin therapy?

- take with food - report ringing in the ears - monitor and report excessive bleeding and bruising - avoid OTC pain meds that contain aspirin

What clinical manifestations are expected of a patient with chronic PVD?

-edema of the feet and ankles - reddened and painful areas on the calves - ulcers around the ankles with a dull ache in the legs

How long can a PICC line be used?

7 days to several months

What is the first and most reliable indicator of early heart failure in infants?

a quicker respiratory rate due to the stress placed on the lungs from pulmonary edema

What is the nurses concern when caring for a patient just daignosed with ruptured tubal pregnancy?

diminished CO from uncontrolled bleeding - decreased circulating blood volume (hypovolemia)-> decreased cardiac output

What are some causes of sinus tachycardia?

hypovolemia, HF, anemia, exercise, stimulant use, fever, sympathetic response to fear or pain, anxiety

What should be the immediate action taken by the nurse after finding the patient's lithium level is 2.0?

implement seizure precautions immediately

What is the term for a PVC that look different and occur in different directions?

multifocal PVCs

What are the signs/sx indicating dogoxin overdose/ toxicity?

n/v, bradycardia, anorexia, and dysrhythmias

What priority assessment findings would the nurse expect to see when caring for a patient with sinus tach?

orthopnea, SOB, decreased Bp

What ECG changes would you expect to see in a patient with hyperkalemia?

peaked T-waves

Where is a PICC line inserted?

peripherally (basilic or cephalic vein at AC)

What is cor pulmonale?

right sided heart failure caused by pulmonary hypertension secondary to COPD

What type of mediation is indicated for management of cardiogenic shock?

smypathomimetics - vasopressors that induce arterial constriction, which increase venous return and cardiac output

What clinical finding is the nurse most likely to identify when completing a history and physical assessment of a client with complete heart block?

syncope

after cardiac catheterization a patients UO is 3xs the fluid intake. What is the likely cause of the high urinary output?

the dye used is hypertonic and has a diuretic effect

Which area would the nurse place the stethoscope when taking an apical pulse?

the mitral area: the area where the 5th ICS intersects the midclavicular line

Which finding in a patient who was just admitted would cause the nurse to anticipate insertion of a temporary pacemaker?

third- degree heart block

Why is troponin a good test to monitor when a patient is admitted with ACS?

troponin because they will elevate 2-4 hours after MI and are not found in healthy adults

What discharge teaching should be given to a patient that has just had a femoropopliteal bypass graft?

- begin taking short walks and gradually increase frequency and distance - avoid hot or cold temperatures because they can injure extremities with poor perfusion - continue use of anti-platelet medications to prevent arterial thrombus in vessels with poor perfusion - do not elevate the legs because it can decrease arterial blood flow through the graft

What are the s/sx of digoxin toxicity?

- bradycardia -HA - dizziness - confusion - nausea - visual disturbances (blurred of yellow vision) - ECG findings may include heart block, atrial tachycardia with block, or ventricular dysrhythmias, all causing an irregular pulse

what EKG changes would you see in a patient with hypokalemia?

- bradycardia - prolongation of the PR interval - prolongation of the QRS duration

what non- cardiac symptoms would be seen in a patient with hypokalemia?

- constipation - anorexia

Which adverse hemodynamic effects typically occur when a client develops tachycardia?

- decreased ventricular filling time - lower cardiac output - weaker pulse quality

After noting a patient has a non-fetal dysrhythmia what should the nurse do next?

- determine if the patient is hemodynamically stable by checking the BP - assess the clients home medications, caffeine use, and alcohol consumption after determining the patient's hemodynamic status

A patient with left ventricular HF and SVT is prescribed digoxin 0.25 mg daily. Which changes would the nurse expect to find if this medication is therapeutically effective?

- diuresis: dig increases kidney perfusion --> urine formation and diuresis - decreased edema - decreased pulse rate

When teaching a patient with HF about s/sx that indicate a need to contact the primary health care provider, which clinical manifestations would the nurse include?

- extreme/ unusual fatigue - coughing at night - difficulty breathing

Which findings occur with orthostatic hypotension?

- feeling of faintness - decreased systolic pressure (compression of the VC that hinders venous return --> decrease in the systolic pressure and decreases blood flow to the brain)

what is the expected therapeutic effect of digoxin?

- increased contractile force of the myocardium - slows the HR - increases CO - increase the stroke volume of the heart - decreases the refractory period of the AV node and decreases conduction through the SA and AV nodes

What are the nursing responsibilities when caring for a patient with a PICC line?

- keep dressing secured and sterile - keep line patent by flushing at intervals as ordered and assess patency Q shift

What is the result on the muscles when there is an increase in potassium?

- muscle weakness -areflexia - dysrhythmias (fetal cardiac rhythms such as complete heart block, asystole, and v-fib) - hyperactive bowel sounds - diarrhea

What would you expect to see in a client with dehydration?

- oliguria - hypotension - tenting skin turgor - decreased CO

What clinical findings would the RN expect when assessing a client who has cardiogenic shock?

- pallor - narrow pulse pressure -agitation - increased respiratory rate/ SOB - tachycardia - diaphoresis - HPTN (systolic usually below 90 mmHg)

What findings will cause the nurse to suspect cardiac tamponade in a client who has had cardiac surgery?

- pulsus paradoxus (rapid, thready pulse) - muffled heart sounds - JVD - hypotension - narrowed pulse pressure - as CO decreases, there is a decrease in kidney perfusion and a decrease in urine output

What findings are consistent with a client diagnosis of R-sided-HF?

- right-sided: increased systemic venous pressure and congestion as manifested by an enlarged liver with possible ascites - distended neck veins - distended abdomen - dependent edema - decreased appetite (anorexia) - fatigue - RUQ discomfort - swollen hands and fingers

What are the s/sx of heart failure in an infant?

- tachycardia - tachypnea - UO decreases

What discharge teaching should be given to a patient with a newly implanted pacemaker?

- take pulse daily and report changes below a set level with the HCP - Notify the HCP if there is swelling or drainage at the incision - inform airport security about the presence of a pacemaker if you are traveling - avoid strong magnets and power plants

What is the concern when HF patients taking daily furosemide has a BUN of 42 and a creatinine of 1.1? Would the nurse administer the scheduled furosemide? what other interventions should be considered?

- the BUN and creatinine are elevated which could occur because of hypovolemia caused by diuresis or because of poor renal perfusion caused by HF - notify the HCP about the lab results and anticipate a change in the tx plan to prevent futher stress on the kidneys - strict I&O will likely be ordered for the future - urine specific gravity testing may be needed to determine the kidney's ability to concentrate urine in the future

What would be the reason to prescribe atenolol for a patient with hyperthyroidism?

- to reduce the cardiac manifestations: tachycardia, a-fib, and systolic hypertension - CO is increased in hyperthyroidism

What are the 4 types of CVADs?

1. peripherally inserted central catheter (PICC) 2. nontunneled central line 3. tunneled central line 4. implanted ports

What is the treatment for a patient with PEA?

CPR, defib, epi

A patient admitted to the ED with crushing chest pain and a dx of ACS is suspected. Which medication is indicated to prevent progression to a MI?

early administration of ASA in the setting of Mi has been demonstrated to significantly reduce mortality.

What lab results would the nurse request from a patient with a STEMI?

elevations of troponin I and troponin T

A patient has suddenly developed a second degree heart block type I with a rate of 48 beats/min. what action would the nurse take first?

first action would be to assess the patient to see if they are tolerating the block well. the block is transient and usually well tolerated.

why are antibiotics prescribed prophylactic before dental procedures?

help prevent endocarditis

What are the most common signs and symptoms of right-sided-heart failure?

hepatomegaly, weight gain, JVD, and peripheral edema

what would the nurse suspect in a patient complaining of extreme thirst after a major abdominal surgery?

hypovolemic shock -- extravascular fluid depletion leads to the client feeling thirsty

How are incompatible drugs given to a patient with a PICC line?

in separate ports

What does PTH do?

increased blood Ca levels

What clinical manifestations are expected of a patient with chronic PAD?

intermittent claudication ( pain when exercising) and thickened toenails

what HR differentiates V-tach and SVT?

it is v-tach when it is 140-180 bpm; it is SVT when the rhythm is regular and the rate is 150 or more

What does erythropoietin do?

its released by the kidneys to stimulate the production of RBCs

Is hypertension associated with left or right-sided-heart failure?

left-sided

What are the indications for inserting a central venous access device?

long term IV therapy: - fluids - chemo - nutrition - blood products - vesicants (meds with pH <5 or >9, osmo >600)

What does Renin do?

responds to decreased renal perfusion and helps regulate BP

What diagnostic test will the nurse review after noticing large U waves on the ECG for a client who was just admitted to the cardiac unit?

serum potassium - large U waves indicate possible hypokalemia. this needs to be decreased to decrease dysrhythmia risk

What is the purpose of diltiazem hydrochloride?

slow down the heart rate

What would you expect to be the first signs of cardiac failure in the immediate postpartum period?

tachypnea and dyspnea

How should the HR of a patient with chronic a-fib be taken and why?

take the apical pulse over a full minute to determine the actual HR. A-fib patients frequently have a pulse deficit

What would be a concern for a patient with heart failure who is taking digoxin that also has PVCs?

the patient may be experiencing digoxin toxicity as indicated by the PVCs. Other EKG changes that indicate toxicity include v-tach and v-fib

A PVC occurring during which part of the cardiac cycle would be the most concerning?

the t-wave: this is the time when the ventricles should depolarize, so if the ventricles have no time to rest that is bad

What do T3, T4, and TSH lab results measure?

thyroid hormone production

What is diltiazem used for?

to treat rapid atrial defib

Which laboratory test is most important for the nurse to monitor when a client is admitted with acute coronary syndrome?

troponin