Med Surg 3: EXAM 1

The following day, Mr. Gruppman's vital signs are as follows: T 38.2°C, BP 138/72,SpO 96% on 2 L/m, pain 0. His troponin continues to rise, his FBS is 140, and his remaining metabolic lab findings are WNL. His continuous ECG monitoring shows occasional Premature Ventricular contractions (PVCs) and the nurse reviews standing orders for this dysrhythmia. Mr. Gruppman has new orders to get up in a chair, his captopril is increased to three times per day to help prevent Ventricular Remodeling, and he is to start atenolol 50 mg twice a day. Mr. Gruppman asks why his "heart labs" keep increasing and wonders if he is having another heart attack. What is the ideal response that the nurse should provide?

"Cardiac marker labs continue to rise for 24 to 48 hours after your heart attack. They should start to fall tomorrow.

Mrs. Milhouse continues under observation in the ED on a cardiac monitor. Her husband, who is sitting with her, suddenly calls out for help. When the nurse enters the cubicle she finds Mrs. Milhouse unresponsive and experiencing another run of SVT. Her heart rate is 225. The MD orders adenosine (Adenocard) 6 mg IV push. When Mrs. Milhouse's SVT does not resolve, the second bolus of 12 mg is given 2 minutes later, resolving her SVT. Mrs. Milhouse's husband asks the nurse to explain "in layman terms"what SVT is. What would the nurse's best answer be?

"She has an extra conduction pathway in her heart; this causes her heart to beat much faster."

Mr. Gruppman wonders why his blood sugar is so high - "I don't need diabetes on top of everything else!" What should the nurse tell him?

"Your nervous system is causing increased levels of sugars and fats to help your damaged heart muscle function."

for asystole rhythm according to the ACLS 2020 Adult Cardiac Arrest Algorithm, what interventions and medications would you anticipate for this rhythm?

-CPR -Epinephrine

A patient tells the nurse that he has chest pain into his left arm while moving a heavy trash can that lasted for about 10 seconds an stopped once he put the trashcan down. This information would be included in which aspects of the PQRST assessment for chest pain?

-Q -R -T

An elderly client presents to the CCU with complaints of SOB, N/V, weakness, and indigestion pain of 10. What electrocardiogram changes should the nurse anticipate occurring if the client is suffering from unstable angina?

-Q wave elevation -T wave inversions

Which of the following if observed on the cardiac monitor, requires an intervention? (Select all that apply.)

-QRS interval is 0.20 seconds -PR interval is 0.30 seconds

Mrs. Brandon was diagnosed with atrial fibrillation. her vital signs are stable, but she reports that she has felt these "palpitations" in her chest for over two weeks. The nurse would discuss which topics with Mrs. Brandon before she is discharged home? (Select all that apply.)

-The purposes and use of anticoagulation -Possible side effects of beta-blocking agents -Signs and symptoms of stroke and pulmonary embolism

An ICU patient is on arterial pressure monitoring. The nurse noticed the physiologic monitor alarm sounds. Which of the following indicate correct nursing actions? Select all that apply

-check to see whether the catheter is kinked -make sure that there is sufficient pressure in the pressure bag -check the patency of the catheter -check to see whether the stopcocks are turned the wrong way

Your patient has a MAP of 52. What physical assessment findings would you suspect a patient with this MAP to have? (Select All that Apply)

-decreased level of consciousness -decreased urine output -cyanotic extremities

Administration of the fibrolytic agent alteplase includes certain tasks such as ECG and heart and lung assessments. Which of the following are the other expected tasks in nursing assessments and interventions during the administration of the fibrolytic agent alteplase? Select all that apply.

-expect reperfusion dysrhythmias -assess neuro signs every 15-30 minutes -monitor for evidence of internal or external bleeding

Mr. Christopher was admitted to the ICU for the treatment of acute kidney injury. When evaluating Mr. Christopher's laboratory results, the nurse is particularly concerned that which electrolyte imbalances would cause rhythm disturbances? (Select all that apply.)

-hypokalemia -hyperkalemia -hyponatremia -hypernatremia

The critical care nurse is caring for a client with sinus bradycardia. Which of the following findings requires the nurse to intervene? (Select all that apply.)

-hypotension -dizziness -angina

A patient who was stabbed multiple times in the chest and abdomen has just returned from emergency surgery. Hemodynamic monitoring was initiated during surgery and now reveals that the patient's central venous pressure has dropped to 2 mmHg. The nurse would assess for findings of which conditions? Select all that apply.

-internal hemorrhage -vasodilation from drugs administered during surgery -fluid loss during surgery

Mr. Gruppman expresses that he is worried he is going to have another heart attack and end up "crippled." Which of the following would be appropriate interventions? (Select All That Apply)

-listen to Mr.Gruppman in a non-judgmental, interested manner -determine what Mr.Gruppman knows about how an MI occurs and what his course of rehab will be -correct any misconceptions and provide additional information as needed -encourage him to express what, specifically, he is afraid of -assess his knowledge and beliefs, and correcting misconceptions will help lower anxiety levels, knowledge will give him a sense of control

The nurse writes a nursing diagnosis for Mr. Gruppman of Ineffective Cardiac Tissue Perfusion related to decreased coronary blood flow with a goal to decrease chest pain. Which of the following are appropriate interventions for this goal? (Select All That Apply).

-monitor ECG -administer medications as ordered -Assess pain, including location, intensity, radiation, duration, factors affecting pain as well as associated symptoms such as nausea, etc. -administer oxygen -Monitor BP, heart sounds and rate, LOC, I/O, skin color

What assessment finding would necessitate holding a client's usual morning dose of digitalis (digoxin)?

-sinus rate of 62

A client is having PVCs. Which circumstance would warrant the nurse's notifying the health care provider? Select all that apply.

-the nurse notes more than 6 PVC's in a 1-minute ECG strip -there are more than 3 PVC's in a row -the PVC's begin to occur in sets of two

Your patient has a BP of 60/40 mm Hg. Calculate your patient's MAP.

46.7 mmHg systolic + diastolic(x2) /3

One hour later, Mr. Gruppman's 12-lead ECG shows an elevated ST-segment in leads V2-V4with a T wave inversion. His CK-MB, troponin I, and myoglobin levels are elevated. His troponin T is normal. Mr. Gruppman is given a diagnosis of anterior wall MI. He is told he has had "a mild heart attack" and will be given a "clot buster" to help restore circulation to his heart. He is started on a 3-hour infusion of alteplase. He is stabilized and transferred to CCU with an hour remaining on his alteplase IV, a heparin drip, and a Foley catheter in place. An anterior wall MI indicates occlusion of which of the following coronary arteries?

Left anterior defending artery

Which of the following was prescribed to decrease cardiac preload and afterload and to increase the blood flow to the myocardium? Mr. Ethan Gruppman, a 55-year-old businessman on a business trip, has been brought to the ED by a colleague with SOB and chest pain. One hour ago, Mr. Gruppman began to experience "indigestion," which was unrelieved by antacid, after a heavy meal. Mr. Gruppman is 5'6" tall and weighs 175 pounds. He has a history of hypertension and high cholesterol for which he takes captopril 50 mg twice a day and simvastatin 20 mg once daily. His father, 74, has had two MIs; his mother recently died of a CVA at age 72. Mr. Gruppman takes frequent business trips, eats fast food and "banquet meals," and works out sporadically. His BP is 178/90, P 104, R 26, and T 98.8°C. His 12-lead ECG is unremarkable. Orders are given for CXR, continuous ECG monitoring, serial CK-MB, Troponin & Myoglobin as well as a CBC, and metabolic panel. Two IV lines and O2 at 4 L via nasal cannula are started. He is given ASA 325 mg, nitroglycerin 0.6 mg SL, atenolol 5 mg IV over 5 minutes to be repeated in 10 minutes, and morphine sulfate 8 mg IV. His diagnosis is possible Myocardial Infarction, pending further diagnostic test results.

Nitroglycerin

A patient requires the insertion of an arterial catheter. Which nursing action is indicated?

Obtain sterile gowns, gloves, caps, and masks for all persons who will be present during the insertion

Which of the following is the normal cardiac electrical conduction pathway?

SA node, Bachmann's bundle,AV node, the bundle of His, right and left bundle branches, purkinje fibers

atrial fibrillation

absence of p waves

p wave

atrial depolarization

The nurse is assessing a patient's arterial waveform and notes a notch on the descending portion of the waveform. The nurse associates this notch with which physiological events?

closure of the aortic valve

Mr. Christopher's morning potassium is 2.0 mEq/L. As a result, the nurse identifies which nursing diagnosis as having the greatest priority?

decreased cardiac output

atrial fibrillation can cause

decreased cardiac output, decreased blood pressure

Which of the following is the most important principle the nurse considers in planning post-MI patient education?

establish the patients priorities and plan to teach around them

A critical care nurse is assessing the patient's ECG strip. The client's ECG strip reveals a rate of 85 bpm, P waves preceding every QRS, a QRS following each P wave, a PR interval of 0.27 seconds, and a QRS of 0.09 seconds. How should the nurse interpret this rhythm?

first degree AV block

The ECG of a patient presented to the ED with symptoms consistent with ACS, shows ST segment elevation. What is the nurses priority action?

give the patient 325 mg of Aspirin

A client has received atropine for symptomatic sinus bradycardia. Which outcome indicates to the nurse that this drug is having the desired effect?

increase heart rate

Mr. Gruppman has an uneventful recovery and is discharged from the hospital on his fourth day. He will be attending outpatient cardiac rehab for 6 weeks for heart health education, increase his physical activity, and will attend support group therapy. He is being discharged on his pre-admission medication, with captopril increased to three times/day, and the addition of prn sublingual nitroglycerin and atenolol 50 mg twice/day. Although Mr. Gruppman states he is happy to be going home, he appears to be depressed and anxious. Prior to his discharge, Mr. Gruppman has a low-level treadmill test without evidence of ischemia. Based on this result, what information should he be given about his target heart rate during physical activity?

isometric excercies would be better for him than isotonic exercises

A critical care nurse is caring for a patient who is receiving Amiodarone for the management of dysrhythmias. Which of the following statements is correct about Amiodarone?

it slows the heart

the patient requires close monitoring during the first 24 hours after receiving thrombolytic therapy. What is the priority nursing intervention?

monitor level of consciousness

Critical care nursing is interpreting the patient's ECG. The nurse noted the following: HR 80 bpm, R-R intervals are regular, each P wave looks the same, the PR interval is 0.12 seconds, each P wave is followed by a QRS, the QRS complex is 0.11 seconds, and the QT interval is half the R-R interval. How should the nurse interpret this rhythm?

normal sinus rhythm

The nurse is caring for a patient who has undergone cardioversion for the management of a tachy dysrhythmia. Which outcome on the ECG would the nurse evaluate as indicating that cardioversion has been successful?

normal sinus rhythm

Ms. Gloria Milhouse, a 68-year-old woman, is driven to the ED by her husband who states she "passed out" while riding in the car and he had a difficult time rousing her. She is pale and anxious, her BP is 160/82, and her apical pulse is 114 and regular. During her intake interview, Mrs. Milhouse reveals that she passed out 2 weeks ago at home but recovered quickly. She admits to having frequent heart palpitations and a feeling that her heart is "racing." She denies alcohol or tobacco use and drinks one cup of coffee a day. Suspecting a cardiac dysrhythmia, the MD places Mrs. Milhouse under observation on a cardiac monitor While the technician is attaching the ECG electrodes and the nurse is starting an IV line, Mrs. Milhouse becomes anxious and complains of heart palpitations. The technician quickly attaches the remaining electrodes while the nurse assesses the patient. Her heart rhythm is regular and her rate is rapid; she is pale and anxious, and states she feels "woozy." A few minutes later, Mrs. Milhouse announces her palpitations have stopped. The nurse analyzes her ECG strip and determines that Mrs. Milhouse is experiencing supraventricular tachycardia. How did the nurse determine that Mrs. Milhouse was having a run of SVT, after analyzing the ECG strip?

p waves were absent, her ventricular rate was 200, and the run began and ended abruptly

A diabetic patient presented to the ED with fatigue and shortness of breath was diagnosed with unstable angina. The nursing student is surprised how the patient was diagnosed with unstable angina, however the patient didn't complain of chest pain on admission to the ED. How would the critical care nurse explain this to the nursing student?

persons with diabetes may experience pain differently

The above rhythm is showing the following ECG features: QRS complexes: Present, all shaped the same Regularity: Regular rhythm, HR: 47 bpm P waves: Upright, matching, 1 per QRS, P-P interval regular PR interval: 0.16 seconds, QRS interval: 0.06-0.08 seconds, QT interval: 0.40 seconds

sinus bradycardia

QRS complexes: Present, all shaped the same Regularity: Regular rhythm, HR: 120 bpm P waves: Upright, matching, 1 per QRS, P-P interval regular PR interval: 0.12 seconds, QRS interval: 0.10 seconds, QT interval: not measurable (no measurable T wave in this lead) Which of the following rhythms is displayed in the above ECG strip?

sinus tachycardia

The above rhythm is showing the following ECG features: QRS complexes: Present, all shaped the same Regularity: Regular rhythm, HR: 120 bpm P waves: Upright, matching, 1 per QRS, P-P interval regular PR interval: 0.14 seconds, QRS interval: 0.08 seconds; QT interval: 0.32 seconds Which of the following rhythms is displayed in the above ECG strip?

sinus tachycardia

The above rhythm is showing the following ECG features: QRS complexes: Present, all shaped the same Regularity: Underlying regular rhythm with one premature beat, HR: 115; 6th QRS complex occurred earlier than expected. P waves: Underlying rhythm - upright, matching, 1 per QRS; P-P interval regular in underlying rhythm; 5th Pwave occured earlier than expected and appearance does not match PR interval: 0.18 sec. QRS interval: 0.08 sec. QT interval:0.30 sec.

sinus tachycardia with one PAC

Calculate the heart rate by filling in the blanks

six second strip method: 12x10=10 large blood method: 300/2.5=120 small block method: 1500/12.5=120

The QRS interval is equal to 4 small boxes.

slowed ventricular depolarization

A nurse receives a report for the shift. Which client should the nurse plan to see first?

the client with hyperkalemia, prolonged PR interval, and wide QRS complex

Your patient MAP is 52 mmHg, what is your interpretation of this MAP?

the map is low

PR interval

time from SA node stimulation to ventricular depolarization

QT interval

total time for ventricular depolarization and repolarization

Your patient MAP is 52, what interventions would you anticipate for a patient with this MAP? (Select All that Apply)

vasoconstrictors, fluid administration

QRS complex

ventricular depolarization

T wave

ventricular repolarization

Mr. Joshua is on mechanical ventilation after chest trauma. Mr. Joshua is having frequent episodes of dysrhythmia. There are three PVC in a row with a rate of 110. There are no identifiable Pwaves, the R-R interval is regular, and the QRS complex is 0.20 seconds. How would the nurse interpret this rhythm?

ventricular tachycardia