aaaaaa nsg 102 important, #2. Pulmonary Embolism, Anticoagulation (Lilley Ch.26) - Textbook, MODS/ARDS/DIC (Infection/SIRS&Sepsis/Severe Sepsis&Septic Shock/MODS) - IGGY Ch 32: Respiratory Problems, Day 8 of the New Year: All about the Heart, #2. Pul...

NPH insulin

"N" cloudy peaks in 5 hours but doesn't fall off as fast

Atrial Flutter

"Saw Tooth"

The clinical test report of a patient who is prescribed nifedipine (Procardia) indicates toxicity. On assessment the nurse finds that the patient has taken the dose as prescribed. What could be the cause of toxicity in the patient?

2. The patient consumes grapefruit juice. (Grapefruit reduces the metabolism of nifedipine and may cause toxicity to the patient.)

Normal Ph

2.5-4.5

Mean cell hemoglobin concentration (MCHC)

32 - 36

PaCO2

35 - 45

WBC

4 - 11

Student Question Banks - Rudd Ch.12 2. The neonatal nurse admits a newborn of a diabetic mother who consumed alcohol daily throughout the pregnancy. The nurse hears a loud pansytolic murmur. What does the nurse suspect? a. Tetralogy of Fallot b. Coarctation of the aorta c. Truncus arteriosus d. Patent ductus arteriosus

a. A loud pansystolic murmur is not associated with Tetralogy of Fallot. b. A pansystolic murmur is not associated with a coarctation of the aorta. c. CORRECT - A loud pansystolic murmur is heard throughout systole because of blood flow from the right to left ventricle as the result of a large VSD. Maternal history supports the likelihood of truncus arteriosus. d. A patent ductus arteriosus will cause a murmur but not a pansystolic murmur.

HbA1c

4-6%

Normal CO is?

4-8 L/min

What does the nurse teach the patient about sublingual nitroglycerin (Nitrostat)?

4. "Sit or lie down after you take a nitroglycerin tablet to prevent dizziness."

The nurse administers candesartan (Atacand) to a patient. Which patient assessment finding should the nurse use as a clinical indicator of therapeutic effectiveness of the medication?

4. Blood pressure 120/72. (ARB's will return the blood pressure to a normal range)

The nurse reviews a patient's laboratory values of digoxin level 10 ng/mL and value of serum potassium 6.2. Which drug does the nurse ask the primary health care provider to administer?

4. Digoxin immune FAB (Digibind). (Digibind is specifically used for Dig overdose. reverses effects such as bradycardia)

Normal Triglyceride

40-50

Rate of Junctional Escape Rhythm

40-60

Hematocrit

42-52 (male) // 37-47 (female)

HgbA1c levels

45-65%

Fluid replacement formula for burns

4mL x % of TBSA burned x wt in kg

Normal WBC

5,000-10,000

Valproic Acid

50 - 100 mcg/mL

valproic acid

50 to 100

ck (creatinine kinase)

50-250

Normal Amniotic Fluid

500-1200mL nitrozine urine- green litmus paper amniotic fluid- litmus paper blue

WBC

5k to 10k

Pediatrics are diaphragmatic breather until ____years.

6 years

Normal Variability

6-10

rate of accelerated junctional rhythm

61-100

Fasting Blood Sugar

70 - 110 mg/dL

Normal Glucose

70-110

Blood Urea Nitrogen (BUN)

8 - 20 mg/dL

AST / ALT

8-40 units

PT

9.5 - 12

SaO2

95 - 100

Normal Cl

95-105

sa o2

95-98

SaO2

95-98%

Chloride

98-106 mMoL/L

Adult vital signs

98.6F (T) 60-100 (HR) <120 - <80 (BP) 12-20 (RR)

Infant vital signs

98.6F (T) 90-160 (FHR) (100-asleep) (180-cry) 60-90 / 40-65 (BP) 30-60 (RR)

Low-density Liproprotein (LDL)

<130

Triglicerides

<150 mg/dL

Bundle of HIS is what?

A collection of heart muscle cells specialized for electrical conduction. It transmits the electrical impulses from the AV node to the point of the apex of the fascicular branches via the bundle branches

Peritonsillar abscess (PTA)

A complication of acute tonsillitis. The infection spreads from the tonsil to the surrounding tissue, which forms an abscess. The most common cause of PTA is group A beta-hemolytic Streptococcus.

hypertrophic cardiomyopathy

A condition in which the heart muscle becomes abnormally thick.

Bundle of HIS

A part of the electrical conduction system that connects the AV node to the bundle branches

Drugs given for CHF

ACE inhibitors Nitrates Diuretics Beta Blockers Cardiac Glycosides Nesiritide Beta Agonists Morphine

high risk population for laryngeal cancer

ALCOHOL SMOKING

stable angina pectoris

ASA III

Conductivity

Ability to transmit impulses from one area to another

Does impulse come above or below the ventricle is QRS is smaller than .12?

Above

Beta blockers

Acebutolol (sectral) atenolol esmolol metaprolol propanolol

Antidote for Acetaminophen

Acetylcysteine (Mucomyst)

Antiplatlet

Alter formation of platlet plug

Antidote for Thrombolytics

Aminocaproic acid (Amicar)

atypical angina

Angina that manifests itself as indigestion, pain between the shoulders, an aching jaw, or a choking sensation that occurs with exertion. Many women experience atypical angina.

Protamine Sulfate

Antidote for Heparin

How does a pacemaker work?

Artificial device that electrically stimulates the myocardium to depolarize, which begins contractions

When palpating chest wall what 3 things should you assess for?

Assess for *depressions, bulges, unusual chest wall shape*

BELOW IS LOWER AIRWAY

BELOW IS LOWER AIRWAY

Sx of Systolic HF

Blood Backs up into pulmonary and systemiv congetion develops Decreased level of conciousness Fatigue Weakness Cyanosis Angina SOB decrease urinary output

By 5 months: infant has enough muscles to react to irritants by ____________ and ____________.

By 5 months: infant has enough muscles to react to irritants by *bronchospasm and muscle contraction.)

*The infant relies primarily on?* A. mouth breathing B. intercostals muscles for breathing C. diaphragmatic abdominal breathing D. all of the above

C. diaphragmatic abdominal breathing

pt. c/o chest disc that occurs w/ mod. to prolonged and describes pain as being "about the same over the past several months and going away with NTG or rest." =

CSA 2nd to CAD

Excitability

Capability to initiate an impulse or stimulus

After having a myocardial infarction (MI), the nurse notes the patient has jugular venous distention, gained weight, developed peripheral edema, and has a heart rate of 108 beats/min. What should the nurse suspect is happening? a. ADHF b. Chronic HF c. Left-sided HF d. Right-sided HF

D An MI is a primary cause of heart failure. The jugular venous distention, weight gain, peripheral edema, and increased heart rate are manifestations of right-sided heart failure.

An 80-year-old patient with uncontrolled type 1 diabetes mellitus is diagnosed with aortic stenosis. When conservative therapy is no longer effective, the nurse knows that the patient will need to do or have what done? A. Aortic valve replacement B. Take nitroglycerin for chest pain. C. Open commissurotomy (valvulotomy) procedure D. Percutaneous transluminal balloon valvuloplasty (PTBV) procedure

D. Percutaneous transluminal balloon valvuloplasty (PTBV) procedure The percutaneous transluminal balloon valvuloplasty (PTBV) procedure is best for this older adult patient who is a poor surgery candidate related to the uncontrolled type 1 diabetes mellitus. Aortic valve replacement would probably not be tolerated well by this patient, although it may be done if the PTBV fails and the diabetes is controlled in the future. Nitroglycerin is used cautiously for chest pain because it can reduce BP and worsen chest pain in patients with aortic stenosis. Open commissurotomy procedure is used for mitral stenosis.

Bleeding from PCI. Removing sheath/ repositioning would exacerbate bleeding and repositioning would not halt it. CPR is not indicated unless there is evidence of respiratory or cardiac arrest.

Would ^ bleeding and positioning wouldn't halt it

Etiology of Accelerated Junctional Rhythm

DIGITALIS toxicity

Etiology of junctional tachycardia

DIGITALIS toxicity

Etiology of first degree AV block

DIGITALIS toxicity MI

cad semi-modifiable risks

DM HTN genetic dyslipidemia = vascular inflammation processes = high sensitivity reactive protein process

can also occur in alcoholics who've contracted an infection or an head injury.

DT

sudden onset of severe and abnormal mental and neurological changes

DT

sudden onset of severe and abnormal mental and neurological changes. It usually follows a period of withdrawal from alcohol, typically in people who have had a high alcohol intake for over a month. However, the symptoms of DTs can also occur in alcoholics who have contracted an infection or have suffered a head injury.

DT

typically in people who have had a high alcohol intake for over a month.

DT

usually follows a period of withdrawal from alcohol.

DT

alcohol intake hx of 6-8 shots per day = ^ risk for what

DT and Laryngeal cancer

Etiology of sinus Bradycardia

Damage to SA node vagal stimulation Increased ICP Certain Drugs (DIGOXIN or BETA BLOCKERS) during sleep normal in athletes

triglycerides

Detects risk for athersclerosis *mg/dL* 100-200

Argatroban

Direct Thrombin Inhibitor

Bivalirudin

Direct Thrombin Inhibitor

Dabigatran

Direct Thrombin Inhibitor

Desirudin

Direct Thrombin Inhibitor

Lepirudin

Direct Thrombin Inhibitor

Transcutaneous Pacemaker

Done in an emergency Non-invasive electrodes (pads) placed on client's anterior chest wall and second placed on back External pulse generator emits pacing impulses that travel through the skin to the heart muscle

Albuterol, which is a medication used to manage asthma and respiratory conditions, will

^ HR

Artifact

ECG waveforms from sources outside the heart (interference seen on a monitor)

Iggy Study Guide Ch.31 6. A patient reports throat soreness and dryness, throat pain, pain on swallowing (odynophagia), and difficulty swallowing. Which disorder does the nurse suspect? a. Pharyngitis b. Tonsillitis c. Rhinosinusitis d. Pneumonia

a

Rivaroxaban

Factor Xa inhibitor

32. (True/False) The term preload refers to the amount of resistance to ejection of blood from a ventricle.

False

47. (True/False) Patient with Reynaud's disease are extremely sensitive to heat exposure.

False

CHF Clinical manifestations

Fatigue Limitation of activities Weight Gain Nocturia

Rudd Ch.12 Pg.246-247 Review Questions 10. A cardiac assessment performed by the nurse includes which of the following? a. Heart rate, respiratory rate, color, blood pressure, pulse oximetry, and pulses b. Heart rate, color, blood pressure, pulse oximetry, and pulses c. Heart rate, respiratory rate, color, and pulses d. Heart rate, respiratory rate, color, and liver edges

a Heart rate, respiratory rate, color, blood pressure, pulse oximetry, and pulses

Atrial natriuretic peptide (ANP)

Found in atria of heart causes excretion of Na & H2o

Purkinje Fibers has what function?

Function is to relay impulses from the bundle to the ventricles, causing a contraction. Causing the contraction of the ventricles to be almost instantaneous. *20-40 beats/min*

Loop Diuretics

Furosemide (Lasix) Bumetanide (Bumex) HCTZ (Thiazide)

hs-CRP (high sensitivity C-reactive protein)

Glycoprotein made by liver, when acute inflammation. Link in development atherosclerosis - stable plaque weakening and rupturing. > 3.0 mg/dL greatest risk 1.0-3.0 mg/dL moderate risk < 1.0 mg/dL low risk

A young patient with a family history of sudden death collapses and dies while exercising.

HCM

Prolonged QT

a rare inherited or acquired heart condition in which delayed repolarization of the heart following a heartbeat increases the risk of episodes of torsades de pointes a form of irregular heartbeat that originates from the ventricles. These episodes may lead to palpitations, fainting ,and sudden death due to ventricular fibrillation.

tissue plasminogen activator (tPA)

a thrombolytic administered to some patients having a heart attack or stroke to dissolve damaging blood clots

A nurse is reviewing self-care measures for a client with peripheral vascular disease. Which statement indicates proper self-care measures? a) "I have my wife look at the soles of my feet each day." b) "I like to soak my feet in the hot tub every day." c) "I stopped smoking and use only chewing tobacco." d) "I walk only to the mailbox in my bare feet."

a) "I have my wife look at the soles of my feet each day." Explanation: A client with peripheral vascular disease should examine his feet daily for redness, dryness, or cuts. If a client isn't able to do this examination on his own, then a caregiver or family member should help him. A client with peripheral vascular disease should avoid hot tubs because decreased sensation in the feet may make him unable to tell if the water is too hot. The client should always wear shoes or slippers on his feet when he is out of bed to help minimize trauma to the feet. Any type of nicotine, whether it's from cigarettes or smokeless tobacco, can cause vasoconstriction and further decrease blood supply to the extremities.

Rule of 9's

Head= 18% Arms= 9% each chest/back= 18% legs= 18% each Genitals= 1%

Anticoagulants

Heparin sodium Enoxaparin sodium (lovenox) Dalteparin sodium (fragmin)

A nurse is caring for a client who is exhibiting signs and symptoms characteristic of a myocardial infarction (MI). Which statement describes priorities the nurse should establish while performing the physical assessment? a) Assess the client's level of pain and administer prescribed analgesics. b) Ensure that the client's family is kept informed of his status. c) Prepare the client for pulmonary artery catheterization. d) Assess the client's level of anxiety and provide emotional support.

a) Assess the client's level of pain and administer prescribed analgesics. Explanation: The cardinal symptom of MI is persistent, crushing substernal pain or pressure. The nurse should first assess the client's pain and prepare to administer nitroglycerin or morphine for pain control. The client must be medically stabilized before pulmonary artery catheterization can be used as a diagnostic procedure. Anxiety and a feeling of impending doom are characteristic of MI, but the priority is to stabilize the client medically. Although the client and his family should be kept informed at every step of the recovery process, this action isn't the priority when treating a client with a suspected MI.

A client who underwent total hip replacement exhibits a red, painful area on the calf of the affected leg. What test validates presence of thromboembolism? a) Homans' b) Rinne c) Romberg's d) Phalen's

a) Homans' Explanation: A positive Homans' sign, or pain in the calf elicited upon flexion of the ankle with the leg straight, indicates the presence of a thrombus. Testing for Romberg's sign assesses cerebellar function. Phalen's test assesses carpal tunnel syndrome. The Rinne test compares air and bone conduction in both ears to screen for or confirm hearing loss.

A client has been diagnosed with peripheral arterial occlusive disease. Which of the following instructions is appropriate for the nurse to give the client for promoting circulation to the extremities? a) Participate in a regular walking program. b) Massage the calf muscles if pain occurs. c) Use a heating pad to promote warmth. d) Keep the extremities elevated slightly.

a) Participate in a regular walking program. Explanation: Clients diagnosed with peripheral arterial occlusive disease should be encouraged to participate in a regular walking program to help develop collateral circulation. They should be advised to rest if pain develops and to resume activity when pain subsides. Extremities should be kept in a dependent position to promote circulation; elevation of the extremities will decrease circulation. Heating pads should not be used by anyone with impaired circulation to avoid burns. Massaging the calf muscles will not decrease pain. Intermittent claudication subsides with rest.

Renal diet

High calorie High carb Low protein Low K Low Na Fluid restriction= output + 500mL

hs-CRP

High sensitive CRP or "cardioCRP" is more specific for cvd's. Baseline hs-CRP is good marker for future cardiovascular events.

To check for arterial insufficiency when a client is in a supine position, the nurse should elevate the extremity at a 45-degree angle and then have the client sit up. The nurse suspects arterial insufficiency if the assessment reveals: a) dependent pallor. b) elevational rubor. c) a 30-second filling time for the veins. d) no rubor for 10 seconds after the maneuver.

a) dependent pallor. Explanation: If arterial insufficiency is present, elevation of the limb would yield a pallor from the lack of circulation. Rubor and increased venous filling time would suggest venous problems secondary to venous trapping and incompetent valves.

Afterload is increased by what factors?

Hypertension Vasoconstriction

Graves Disease

Hyperthyroid weight loss, hot/sweaty, exophthalmos (bulging eyes), decreased attention span, increased appetite, irritable, Increased BP, Thyroid enlargment

A nurse is caring for a patient with stage 3 heart failure. The patient is becoming increasingly short of breath, tired, and confused. Which of the following is the patient at risk for? (select all that apply) a. respiratory acidosis b. cardiogenic shock c. ventricular arrhythmias d. electrolyte imbalances e. endocarditis

a, b, c, d

Lack Na+ re absorption and in turn water

Hypoaldosteronism = addisons disease

What elextrolyte imbalance can cause a U wave?

Hypokalemia

Prophylaxis of re occlusion of artery is

IV Heparin Drip and monitor PTT

Epistaxis treatment

If bleeding cont. post applied pressure x 10min to midline septum additional tx = silver nitrate application, Gelfoam, electrocautery or vasoconstrictors may be used. Suction may be used to visualize nasal septum but doesn't alleviate bleeding. Cessation of nose bleed through oxymetazoline spray, cocaine pledget, cauterization, nitrous oxide, nasal clamp, packing or Rhino Rocket -direct pressure x 15 minutes with ice -lean forward -if still bleeding, afrin -lidocaine then silver nitrate if you can see bleeding area -nasal packing for anterior bleed -refer to ENT or ED if still bleeding -CBC and clotting times if no obvious reason -saline for dried nasal tissue

Immune globulin

Immediate protection Passive Immunity

Impulse Pathway through the Heart

Impulses travel out of the *SA node* and through the *intermodal tracts* and *Bachman's bundle* to the *AV node*. From there to the *bundle of HIS*, the *bundle branches*, and finally the *Purkinje fibers*

Question 4 of 24 The nurse is assessing a client with possible pulmonary embolism (PE). For which symptoms should the nurse assess? Select all that apply. a. Dizziness and fainting b. Shortness of breath (SOB) worsening over the last 2 weeks c. Inspiratory chest pain d. Productive cough e. Pink, frothy sputum

a, c Dizziness and fainting, Inspiratory chest pain Syncope, hypotension, and fainting are symptoms associated with PE. Sharp, pleuritic, inspiratory chest pain is also characteristic of PE. Sudden, not gradual, SOB occurs with PE. Productive cough is associated with infection; PE typically causes a dry cough. Pink, frothy sputum is characteristic of pulmonary edema; PE may cause hemoptysis.

The patient has heart failure (HF) with an ejection fraction of less than 40%. What core measures should the nurse expect to include in the plan of care for this patient (select all that apply)? a. Left ventricular function is documented. b. Controlling dysrhythmias will eliminate HF. c. Prescription for digoxin (Lanoxin) at discharge d. Prescription for angiotensin-converting enzyme (ACE) inhibitor at discharge e. Education materials about activity, medications, weight monitoring, and what to do if symptoms worsen

a, d, & e The Joint Commission has identified these three core measures for heart failure patients. Although controlling dysrhythmias will improve CO and workload, it will not eliminate HF. Prescribing digoxin for all HF patients is no longer done because there are newer effective drugs and digoxin toxicity occurs easily related to electrolyte levels and the therapeutic range must be maintained.

alanine aminotransferase (ALT)

Increase liver disease, hepatitis *Units* 10-40

Hemostatic Agent

Inhibit firbrin destruction

CAR pre and postop pt. Ed.

Intubation and mechanical ventilation

Etiology of PVC

Ischemia MI acidosis low K+(most common) Drugs(digitalis) or other catecholamines

Quick tips for IV solutions

Isotonic solutions= stay where I put it HypOtonic solutions= go Out of the vessel HypErtonic solutions= Enter the vessel

Iggy Study Guide Ch.32 15. Which are extrapulmonary causes of ventilatiory failure? (Select all that apply.) a. Stroke b. Use of opioid analgesics c. Pulmonary edema d. Chronic obstructive pulmonary disease e. Morbid obesity

a,b,e

Addison's vs Cushings

It's all about the cortisol Addison's- increase sodium intake, give cortisone preparations Cushings- restrict sodium; observe for signs of infection

Rhythms originating in Atrioventricular (AV) junction =

Junctional Dysrrhythmias

Aldactone makes you retain

K+

Hyperkalemia & burns

K+ is inside cells, burns cause cells to lyse, K+ ions enter vascular space and cause Hyperkalemia

What happens to Cardiac cells at rest?

K+ leaks out Protein and phosphates are negatively charged and remain inside the cell

22. Metabolic syndrome increases the risk for coronary heart disease. Which are indicators of this syndrome? (Select all that apply.) a. Triglyceride level of 170 mg/dL b. HDL cholesterol level of 45 mg/dL in a male c. HDL cholesterol level of 45 mg/dL in a female d. Blood pressure of 130/86 mm Hg while taking a beta blocker e. Fasting blood sugar level of 120 mg/dL

a,c,d,e

Iggy Study Guide Ch.31 9. Which factors can contribute to acute pharyngitis? (Select all that apply.) a. Viruses b. Coughing c. Irritants d. Bacteria e. Alcohol

a,c,d,e

27. A patient is currently pain -and symptom-free, but reports having intermittent episodes of chest pain over the past week. The nurse asks about which associated symptoms? (Select all that apply.) a. Nausea b. Diarrhea c. Diaphoresis d. Dizziness e. Joint pain f. Shortness of breath

a,c,d,f

Iggy Study Guide Ch.31 55. Which people are at greatest risk for developing TB in the United States? (Select all that apply.) a. An alcoholic homeless man who occasionally stays in a shelter b. A college student sharing a room in a dormitory c. A person with immune dysfunction or HIV d. A homemaker who does volunteer work at a homeless shelter e. Foreigh immigrants (especially those from the Phillippines and Mexico)

a,c,e

Iggy Study Guide Ch.32 4. Which conditions define respiratory failure? (Select all that apply.) a. Ventilatory failure b. Circulatory failure c. Oxygenation failure d. Severe anemia e. Combination of ventilatory and oxygenation failure

a,c,e

Jewish religious considerations

Kosher foods

___ exerts harmful effects to coronary vasculature because small ___ particles can easily be transported in vessel lining

LDL LDL

High PCWP may indicate

Left ventricle failure

Dalteparin

Low Molecular Weight Heparin more stable than heparin

Enoxaparin

Low Molecular Weight Heparin more stable than heparin

Heart healthy diet

Low fat (less than 30% of calories from fat)

Gout diet

Low purine Omit poultry Medications for acute episodes: Colchicine Maintenance medication: Zylopirim

> 3k ft =

Lower o2 level

Mechanical valves

Man made valves

Volume replacement

Mild= PO fluids Severe= IV fluids

Intercostal, substernal, subcostal are mild, moderate, or severe distress?

Moderate distress

Gestational Diabetes

Mom needs 2-3x mor insulin screen ALL moms at 24-28 weeks gestation if she has risk factors screen at first visit Baby will be fat and have hypoglycemia Limit protein to 10-20%

Nursing implications for Heparin

Moniter aPTT 1.5-2.5 times normal

GTT 3 hours

More than 125

ST Segment Depression

Myocardial ischemia

Antidote for Opioid Narcotics

Naloxone (Narcan)

Jehovah's Witness religious considerations

No blood products

Atypical angina symptoms

Old DM = Profound weak weakness w/o CP Old Ladies DM patients = jaw ache, arm pain or between shoulders SOB or "choking sensation w/ exertion." cold sweats, dizziness, nausea, indigestion pain between the shoulders, an aching jaw, or a pain between the shoulders, an aching jaw, or a choking sensation that occurs with exertion.

Type 3 block

PR and QRS disassociated

Preload/Afterload

Preload affects the amount of blood going into Right ventricle. Afterload is the systemic resistance after leaving the heart.

beta cells of pancreas

Produce / secrete insulin

ECG changes and Magnesium

Prolonged PRI Prolonged QT PACS Atrial Tach Afib PVCs Torsades de Pointes Tachy

patient presents to the ED in distress and complaining of crushing chest pain. What is the nurses priority for assessment?

Prompting ECG initiation

Refractoriness

Property of being unresponsive to an impulse

Pulmonary Artery Wedge Pressure (PAWP) aka

Pulmonary Artery Occlusive Pressure (PAOP)

PAWP

Pulmonary Artery Wedge Pressure (PAWP) aka Pulmonary Artery Occlusive Pressure (PAOP)

Amlodipine

Reduces hearts workload by decreasing heart rate and myocardial contraction

norvasc

Reduces hearts workload by decreasing heart rate and myocardial contraction

P Wave

Represents atrial depolarization

During a respiratory assessment noticies sinking in of soft tissues relative to the cartilaginous and bony thorax , what does this indicate?

Retractions *(Figure 25-4, p. 842)*

Transcutaneous Pacemaker: Nursing care and intervention

Should not be on for more than a few hours Remove any jewelry, piercings from client Administer pain meds and anti anxiety meds Watch for skin burns Monitor rhythm Monitor vital signs

Tx for maternal hypotension after epidural

Stop pitocin Turn client to left side Oxygen Push IV fluids if hypovolemic

The nurse recognizes that primary manifestations of systolic failure include: a. decreased EF and increased PAWP b. decreased PAWP and increased EF. c. decreased pulmonary hypertension associated with normal EF d. decreased afterload and decreased left ventricular end-diastolic pressure

a. decreased EF and increased PAWP Rationale: Systolic heart failure results in systolic failure in the left ventricle (LV). The LV loses its ability to generate enough pressure to eject blood forward through the aorta. This results in increased pulmonary artery wedge pressure (PAWP). The hallmark of systolic failure is a decrease in the left ventricular ejection fraction (EF).

Stroke volume is?

Stroke volume is the amount of blood pumped out of one ventricle of the heart as the result of a single contraction

Nerve Supply of the Heart

Supplied by two branches of the autonomic nervous system- the sympathetic (or adrenergic) and parasympathetic (or cholinergic)

heart can't contract and eject

Systolic HF

12. Monotherapy is recommended to increase medication compliance when treating hypertension.

T

indicator wave of ischemic damage to myocardium

T inversion

infiltrate to ingest lipids at arterial wall

T lymphocytes and monocytes

ECG changes with Hyperkalemia

Tall peaked T waves Flat P waves, or loss of P widened QRS Prolonged PRI ST depression Vfib/ventricular standstill

A patient with a recent diagnosis of heart failure has been prescribed furosemide (Lasix) in an effort to physiologically do what for the patient? a. Reduce preload. b. Decrease afterload. c. Increase contractility. d. Promote vasodilation.

a. Reduce preload. Diuretics such as furosemide are used in the treatment of HF to mobilize edematous fluid, reduce pulmonary venous pressure, and reduce preload. They do not directly influence afterload, contractility, or vessel tone.

What does the P wave in this figure represent?

The P wave indicates atrial depolarization. The QRS complex represents depolarization from AV node throughout ventricles. The PR interval represents the time it takes the impulse to spread through the atria, AV node, bundle of HIS, bundle branches, and Purkinje fibers to the point immediately preceding ventricular contraction. The U wave, if seen, represents repolarization of Purkinje fibers or the U wave may be associated with hypokalemia. Text Reference - p. 717

Conducting P Wave

The P wave that occurs before the QRS and represents the conduction of the impulse that originates in the atria and continues to the ventricle which is them represented on the graft paper as the QRS waveform.

Textbook Case Studies 3. A.F. has been ill for some time and tells the nurse, "I cannot wait to get to my beach house and relax outside by the ocean. I'm sure the fresh air will be good for me." What is the priority for patient teaching at this time?

The nurse will review the many precautions that the patient should take while on this drug. One particular adverse effect is photosensitivity, which means that the patient should avoid exposure to sunlight. He will have to wear protective clothing and use appropriate sunscreen to prevent sunburn. In addition, this drug may also cause photophobia with continued use, and therefore he needs to use protective sunglasses. These precautions may be disappointing news to this patient.

The pericardial space does what?

The pericardial space separates the visceral and parietal layers and contains 10 to 20 ml of thin, clear pericardial fluid that lubricates the two surfaces and cushions the heart.

Relative Refractory Period

The period during the cardiac cycle in which the cell can respond to a strong stimulus

Lilley Ch.26 pg. Textbook Case Studies In the past 2 years, Mr. L., a 56-year-old architect, has experienced three episodes of deep vein thrombosis. All occurred without complications, and all were treated successfully with anticoagulant therapy and bed rest. He now arrives at the urgent care center because of increased pain and swelling in his left calf that has lasted for the past 3 days. On admission to the hospital for anticoagulant therapy, Mr.L. receives a bolus of 5000 units of heparin and is started on a continuous heparin infusion. 2. What patient findings would indicate a therapeutic response to the heparin therapy?

Therapeutic effects can be observed in several ways. The patient may report an increase in comfort level and decreased pain in the affected leg. The nurse may observe decreased swelling and circumference of the calf area of the leg, decreased heat and redness, increased perfusion as noted through stronger peripheral pulses, and return of normal color and temperature to the affected leg.

Textbook Case Studies A 46-year-old patient, A.F., is admitted to the progressive care unit (PCU) after going to the hospital with complaints of chest pain. He has been on warfarin for several months due to a history of ddep vein thrombosis. In the PCU, A.F.'s heart monitor indicates increased episodes of premature ventricular contractions (PVCs). Just now, the monitor technician calls the nurse to report a 20-second episodes of ventricular tachycardia (VT). When the nurse goes to check A.F., he has another 10-second episode of VT. A.F. has no complaints except for feeling some lightheadedness. His blood pressure is 108/62, and his monitor shows sinus rhythm, rate 72 with frequent PVCs. The nurse notifies the on-call physician and receives orders for an amiodarone (Cordarone) infusion. 1. What is the purpose of the amiodarone infusion?

This drug has also been very effective in the treatment of sustained ventricular tachycardias.

Anistreplase

Thrombolytic Agent

Reteplase

Thrombolytic Agent

Streptokinase

Thrombolytic Agent

Tenecteplase

Thrombolytic Agent

Tissue Plasminogen acvtivator

Thrombolytic Agent

*INSERT: in correct spot- diameter, length* Trachea increases in _______ rather than ____ during the first 5 years.

Trachea increases in *length* rather than *diameter* during the first 5 years.

0.5 mg IV up to 3mg while waiting for pacemaker Transcutaneous pacing Transvenous pacing Dopamine 2-10mcg/kg/min or epinephrine 0.05-0.1 mcg/kg/min( if transcutaneous oaci g not available and pt not responsive to atropine

Treatment for symptomatic bradycardia

Blood flow through the Cardiac Valves: (Tissue--Paper--My--Assets)

Tricuspid --> Pulmonic --> Mitral --> Aortic

The valve from the right atrium to the right ventricle is referred to as?

Tricuspid valve

11. (T/F) Patients with hypertension are often symptom-free.

True

15. (T/F) The elderly population is more sensitive to postural hypotension due to impaired cardiovascular reflexes.

True

21. (T/F) The pathophysiology of atherosclerosis involves an inflammatory response to arterial wall injury.

True

22. Myocardial dysfunction occurs when irreversibly damaged heart muscle is replaced by adipose tissue.

True

23. (T/F) Type 2 diabetics are prone to metabolic syndrome which increases their risk for heart disease.

True

24. (T/F) Blood vessels commonly used to bypass occluded coronary arteries include the saphenous veins of the leg.

True

46. (True/False) A significant symptom of impending rupture of an abdominal aortic aneurysm is severe lower back pain.

True

Ventricular couplets and triplets

Two or three PVCs in a row more than that it is v-tach

IV access and 12 lead Adenosine 6mg IV push. If not conversion 12 mg IV push To control rate Diltiazem

Tx for stable tachycardia with narrow QRS that is regular

Magnesium 2 grams IV over 5 minutes

Tx for stable tachycardia with wide QRS that is irregular

Amiodarone 150mgbiver 10 minutes Calcium Chloride 1gram IV Alternative to amioderone is Lidocaine 1-1.5mg/kg IV every 3-5 minutes up to 3mg Prepare for synchronized cardioversion

Tx for stable tachycardia with wide QRS that is regular

stable angina pectoris

Type of cardiac chest pain that is a result of ischemia that is initiated by increased demand (activity) and relieved with the reduction of that demand (rest).

new or changing chest pain caused by ischemia

UA

When assessing a patient, you note a pulse deficit of 23 beats. This finding may be caused by a. dysrhythmias b. heart murmers c. gallop rhythms d. pericardial friction rubs

a. dysrhythmias

Permanent Pacemakers

Used for chronic heart conditions such as AV block Surgically implanted Most permanent pacemakers are programmed before implantation

creatine kinase (CK)

Used to diagnose acute MI *Detected blood in 3-5 hours 26-174 MM bands present= skeletal muscle damage MB bands present= heart muscle damage

Aminocaproic Acid

Used to tx excessive bleeding

Desmopressin

Used to tx excessive bleeding

Variable decelarations

V shaped on the monitoring strip. Caused by cord compression. Intervention is to change position of mother; if pitocin is infusing, stop the infusion; apply oxygen; increase IV fluids. Contact HCP if problem persists

what leads give you a transverse view of the heart

V1-V6

Nesiritide

Vasodilator ***lab value for BNP no valid for pt on Nesiritide**

Another name for ADH

Vasopressin Desmopressin Acetate *may be utilized as ADH replacement in DI

The Cardiac cycle consists of what?

Venous blood returns to right atrium -->Flows to the right ventricle--> flows to the lung via the pulmonary artery --> oxygenated blood returns to the left atrium--> blood flows to the left ventricle--> Blood leaves the ventricle through the aortic valve and flows to the tissues

Ventricular cells - ___________ pacemaker with an intrinsic rate of ___ - ___ bpm.

Ventricular cells - *Back-up pacemaker* with an intrinsic rate of *20 - 40* bpm.

Torsades de Pointes

Ventricular tachycardia that can be the result of lengthening the QT interval. Literally meaning the "twisting of points" may degenerate into ventricular fibrillation. Common in alcoholics, Magnesium and Potassium replacement very important

EKG Paper: Vertical axis measures _________?

Vertical axis measures *voltage*

Which normal breath sound is low-pitched, swishing, soft expiratory sounds , older children?

Vesicular

lead III

(-) left arm to (+) left leg

lead I

(-) right arm to (+) left arm

lead II

(-) right arm to (+) left leg

Hematocrit

*%* 14-24 (N) 35-45 (C) 35-47 (W) 42-52 (M)

GTT (Glucose tolerance test)

**measures ability of body to secrete insulin in response to hyperglycemia *mg/dL* 60-110 (Fasting) 190 (1 h) 140 (2 h) 125 (3 h)

Pulseless Electrical Activity: PEA

*Often looks like Normal sinus rhythm but there is no palpable pulses* Refers to a clinical diagnosis of cardiac arrest in which a heart rhythm is observed on the electrocardiogram that should be producing a pulse, but is not There is electrical activity, but the heart either does not contract or there are other reasons this results in an insufficient cardiac output to generate a pulse and supply blood to the organs

When a cell is fully depolarized, it attempts to return to its resting state in a process called_______?

*Repolarization* Electrical charges in the cell reverse and return to normal

Afterload

*Resistance that the left ventricle must overcome in order to circulate blood* Is the amount of pressure the left ventricle must work against to pump blood into circulation. The greater this resistance, the more the heart works to pump out blood *Increased afterload = Increased Cardiac workload*

platelet count (thrombocyte count)

*Used to diagnose hemorrhagic diseases, thrombocytopenia *mm3* 150,000-450,000

*Tight breath sounds:* -______ pitched -________ sound. -Small airways have severe _______________.

-*High* pitched -*Squeaking* sound. -Small airways have severe *bronchoconstriction*

*Stridor (adventitious sounds)* -________-pitched inspiratory or expiratory? crowing sound -Originates in _______ or ______. -Upper or Lower airway obstruction from swollen inflamed tissues or lodged foreign body -Heared with _______ or ______.

-*High-pitched inspiratory crowing sound* -Originates in *larynx or trachea* -*Upper airway* obstruction from swollen inflamed tissues or lodged foreign body -Heard with *croup or epiglottitis*

*Respiratory Assessment: Inspection* -________ of chest movement -________ breathers until 6-7 years -Color of _____.

-*Symmetry* of chest movement -*Abdominal* breathers until 6-7 years -Color of *skin*

BE

-2 to +2

*What 2 lobes do you listen to on each side?* -Anterior: -Posterior:

-Anterior: *upper and middle lobes* -Posterior: *upper and lower lobes*

-At birth ____ million alveoli, not fully developed -After ___ years old, alveoli increase in size and complexity -______ million by adulthood

-At birth *25 million* alveoli, not fully developed -After *8 years old*, alveoli increase in size and complexity -*300* million by adulthood

What are the 3 levels of consciousness r/t hypoxia? (in order to mild>moderate>severe hypoxia)

-Irritability/Confusion -Lethargy -Agitation

*LOWER AIRWAY SIDE NOTES* -Respiratory problems can be structural (ex: problem with bronchi), functional (ex: gas exchange problem), or both -Lower rate of an infection for first 3 months of birth since has moms antibodies (so if sick in first 3 months that's a problem and they will have a full workup of assessment, CBC, and other things) -Toddlers and preschoolers have a lot more problems since share and touch a lot of things. -Babies airway is shorter and narrower so there is more airway resistance (so have greater risk for respiratory distress since mucous, inflammation, and other things can be a problem) -Simple interventions for resp problem= reposition -Little kids love to put small things in their mouth. If have a small part can only go 2 places: Pocket or trash!

-Respiratory problems can be structural (ex: problem with bronchi), functional (ex: gas exchange problem), or both -Lower rate of an infection for first 3 months of birth since has moms antibodies (so if sick in first 3 months that's a problem and they will have a full workup of assessment, CBC, and other things) -Toddlers and preschoolers have a lot more problems since share and touch a lot of things. -Babies airway is shorter and narrower so there is more airway resistance (so have greater risk for respiratory distress since mucous, inflammation, and other things can be a problem) -Simple interventions for resp problem= reposition -Little kids love to put small things in their mouth. If have a small part can only go 2 places: Pocket or trash!

*Pediatric Upper Airway* -The only time a newborn breathes through the mouth is with ________. -Coordination of mouth breathing is controlled by maturing __________ pathways

-The only time a newborn breathes through the mouth is with *crying* -Coordination of mouth breathing is controlled by maturing *neurologic pathways*

Explain tactile fremititus? and how do you peform it on a child?

-The vibration/tingling sensation palpated (crying and talking produce vibrations palpated on the chest ) -Place hand on chest child say Mickey Mouse or ice cream (dont do this as much because we just use chest xray)

*Pediatric Upper Airway* -Thyroid, cricoid, and tracheal cartilages immature, easily collapse with neck flexion -Trachea is shorter, angle of bifurcation of right bronchus more acute

-Thyroid, cricoid, and tracheal cartilages immature, easily collapse with neck flexion -Trachea is shorter, angle of bifurcation of right bronchus more acute

mechanical valve prosthesis replacement

-long lasting -will require anticoagulation long term

*LOWER AIRWAY SIDE NOTES * -lungs rely on diaphragmatic up to age 6 (tummy raise) -after age 6 will become thoracic breathing -pay attention to what their ribs look like front and back!

-lungs rely on diaphragmatic up to age 6 (tummy raise) -after age 6 will become thoracic breathing -pay attention to what their ribs look like front and back!

Erythrocyte sedimentation rate (ESR)

0-15 (female)// 0-20 (male)

ESR

0-20

bilirubin total

0.1 to 1

digoxin: normal dosage average dose therapeutic levels

0.125-0.5 mg is normal 0.25 avg 0.5-2 nanograms = therapeutic

how long is systole

0.3 seconds

Creatinine

0.5 - 1.2 mg/dL

Digoxin

0.5 - 2.0 ng/mL

how long is diastole

0.5 seconds

lithium: therapeutic level

0.5-1.5

Therapeutic Digoxin level

0.5-2.0

Lithium

0.8 - 1.2 mEq/L

Therapeutic Lithium level

0.8-1.5

lithium

1 to 1.5

CAD: modifiable risk factors of Atherosclerosis

1) cigarette smoking 2) high BP 3) elevated cholesterol level 4) obesity 5) inactivity 6) stress

The normal duration of the QRS complex is: a. 0.06 to 0.12 seconds b. 0.12 to 0.20 seconds c. 0.36 to 0.44 seconds

a. 0.06 to 0.12 seconds

Which statement by the nursing student about the use of medicinal nitrates indicates effective understanding?

1. Medicinal nitrates dilate all blood vessels.

Normal specific gravity

1.01-1.03

urine specific gravity

1.01-1.03

Red cell distribution width (RDW)

11.5 - 14.5

how much is venous pressure

117 mmHg (100 mmHg overcoming gravity)

provides information that assists in ruling out or diagnosing an acute MI

12 lead ECG

provides information that assists in ruling out or diagnosing an acute MI. It should be obtained within 10 minutes from the time a patient reports pain or arrives in the ED.

12 lead ECG

should be obtained within 10 minutes from the time a patient reports pain or arrives in the ED.

12 lead ECG

Reducing the hearts workload by decreasing heart rate and myocardial contraction

12 lead EKC

provides information that assists in ruling out or diagnosing an acute MI

12 lead EKC

Hgb

12 to 18

Normal Hgb

12-16 women 14-18 men

prehypertension

120-139/80-89

Normal Fetal Heart Rate

120-160

Normal total cholesterol

130-200

Normal Na

135-145

how much is capillary pressure

137 mmHg

Hemoglobin

14-18 (male) // 12-16 (female)

Cholesterol

140 - 200

Phenobarbital

15 - 40 mcg

Water is considered stagnant after ______

15 minutes

ammonia

15-45

Platelets

150 - 450

A goal is also to keep triglyceride levels less than ___

150 mg/dL.

Hr for Vtach

150-250

Stable angina tx

1ST LINE - B BLOCKER= REDUCES O2 DEMAND BY LOWERING CONTRACTILITY ((dont give b blocker if pt has hypotension or low bp) === 2ND LINE (use if CI to B- blocker or pt cant tolerate b blocker SE or if B blocker alone not working NITRATES --->use short acting in ACUTE setting CALCIUM CHANNEL BLOCKER ================= FOR PREVENTION AG angina: ASPIRIN STATIN STOP SMKING, EXERCISE

INR Coumadin

2-3.5

In order to understand pharmacologic therapy for hypertension, what will the nurse teach the patient?

2. Blood pressure is a product of cardiac output and vascular resistance. (CO ranges from 4-8L/min) (SVR = BP divided by the CO)

What assessment finding indicates the patient is having an adverse effect of adrenergic drug therapy for HTN?

2. Heart rate 40 BPM. (bradycardia is the most common adverse side effect of adrenergic drug therapy)

*When assessing a 4 year olds chest the nurse would expect?* a. movement of the chest wall to be symmetric bilaterally and coordinated with breathing b. respiratory movements to be thoracic c. anteroposterior diameter to be equal to the transverse diameter d. retraction of the muscles between the ribs on respiratory movement

a. movement of the chest wall to be symmetric bilaterally and coordinated with breathing movement

what do atrial stretch receptors detect

activated by increased venous return and reduce BP and blood volume by increasing HR

ACS

acute coronary syndrome

ACS stands for what?

acute coronary syndrome

Peak level is drawn

after the 4th dose

where are baroreceptors located

aortic arch and carotid sinus

"Valve replacement is required with _______."

aortic stenosis

APETM

aortic, pulmonic, erb's point, tricuspid, mitral

Immediately after nasal fx the nurse

applies ice and encourages pt to keep the head elevated.

By monitoring serial ECG changes over time the location, evolution, and resolution of an MI can be identified and monitored; life-threatening _______ are the leading cause of death in the first hours after an MI.

arrhythmia

leading cause of death first hours post MI.

arrhythmia

An 82-year-old man living alone at home had a sudden onset of chest pain. He called 911 and was taken to the emergency department (ED).3. What other drugs might the physician prescribe at this time and why?

aspirin = inhibits both platelet aggregation and vasoconstriction decreasing likelihood of thrombosis. Glycoprotein (GP) IIb/IIIa inhibitors target the platelet component of the thrombus = Abciximab (ReoPro), eptifibatide (Integrilin), tirofiban (Aggrastat) = may be given IV as it prevents fibrinogen attachment to activated platelets at thrombus site inhibiting platelet aggregation by PREVENTING FIBRIN BINDING PLATELETS

thrombus formation risk w/ stent, pt receives antiplatelets = ___. Ibuprofen and acetaminophen are not antiplatelet drugs. Dipyridamole is not the drug of choice following stent placement.

aspirin and clopidogrel

while dx is being confirmed pt. with suspected MI is given aspirin, nitroglycerin, morphine, an IV beta- blocker, and other medications, as indicated, while the diagnosis is being confirmed. Tylenol, warfarin, and oxycodone are not typically used.

aspirin, nitroglycerin, morphine, an IV beta- blocker

assessing patients family hx for three generations r/t what respiratory disease most likely

asthma

Do not give beta blockers to

asthmatics or diabetics

pre inv dental op manipulating gingiv tissue, periapical area of teeth or when perforating oral mucosa

atbx

what's the difference between arteriosclerosis and atherosclerosis

atherosclerosis is a form of arteriosclerosis where localized plaques (atheromas) reduce flow in artery main cause of CAD

P wave

atrial depolarization 0.12-0.20 seconds

Etiology of PACs

atrial stretch(seen in valve disease, CHF, liver disease, pulmonary hypertension.) mitral valve prolapse emotional upheaval nicotine caffeine DIGOXIN

Many women experience ___ angina

atypical

Asian cultural considerations

avoid direct eye contact feet are considered dirty (assessed last) males make decisions refuse organ donation avoid hot/cold drinks

Mexican cultural considerations

avoid direct eye contact with authorities refuse organ donation very emotional during bereavement avoid hot/cold drinks

11. Which statement about CAD is accurate? a. Ischemia that occurs with angina lasts more than 30 minutes and does not cause permanent damage of myocardial tissue. b. Postmenopausal women in their 70s have the same incidence of MI as men. c. Many patients suffering sudden cardiac arrest die before reaching the hospital due to atrial fibrillation. d. studies have shown that CAD in women manifests with the same symptoms as with men.

b

13. People should seek treatment for symptoms of MI rather than delay because physical changes will occur approximately how many hours after an infarction? a. 3 hours b. 6 hours c. 12 hours d. 24 hours

b

15. The nurse is auscultating the heart of a patient who had an MI. Which finding most strongly indicates heart failure? a. Murmur b. S3 gallop c. Split S1 and S2 d. Pericardial friction rub

b

2. Which of the following areas does angina pectoris typically radiate to? a. Lower abdomen b. Neck and jaw c. Flank area d. Back of the neck

b

3. How long does angina pain typically last? a. Less than 1 minute b. Less than 5 minutes c. 5-10 minutes d. 10 minutes or more

b

4. How long do you wait between position changes when assessing orthostatic vital signs? a. 1-minute b. 2-minute c. 4-minute d. 5-minute

b

A patient with a history of chronic heart failure is hospitalized with severe dyspnea and a dry, hacking cough. She has pitting edema in both ankles, and her vital signs are blood pressure 170/100 mm Hg, pulse 92 beats/min, and respirations 28 breaths/min. The nurse recognizes that the patient's symptoms indicate a. that venous return to the heart is impaired, causing a decrease in cardiac output. b. impaired emptying of both the right and left ventricles, with low forward blood flow. c. the right side of the heart is failing to pump enough blood to the lungs to provide systemic oxygenation. d. the myocardium is not receiving enough blood supply through the coronary arteries to meet its oxygen demand.

b

Iggy Study Guide Ch.31 62. A patient has an HIV infection, but the TB skin test shows an induration of less than 10 mm and no clinical symptoms of TB are present. Which medication does the patient receive for a period of 12 months to prevent TB? a. Bacille Calmette-Guerin (BCG) vaccine b. Isoniazid (INH) c. Ethambutol d. Strptomycin

b

Iggy Study Guide Ch.32 19. An older adult patient on anticoagulation therapy for a PE is somewhat confused and requires assistance with activities of daily living (ADLs). Which instruction specific to this therapy does the nurse give to the unlicensed assistive personnel (UAP)? a. Count and report episodes of urinary incontinence. b. Use a lift sheet when moving or turning the patient in bed. c. Assist with ambulation because the patient is likely to have dizziness. d. Give the patient an extra blanket, because the patient is likely to feel cold.

b

Iggy Study Guide Ch.32 2. What is the most common site of origin for a clot to occur, causing a PE? a. Right side of the heart b. Deep veins of the legs and pelvis c. Antecubital vein in upper extremities d. Subclavian veins

b

Iggy Study Guide Ch.32 24. The nurse is reviewing lab results for a patient with a new-onset PE. What is the INR therapeutic range? a. 1.0-1.5 b. 2.0-3.0 c. 3.0-4.5 d. 5

b

Iggy Study Guide Ch.32 8. The nurse suspects a patient has a PE and notifies the provider who orders an arterial blood gas. The provider is en route to the facility. The nurse anticipates and prepares the patient for which additional diagnostic test? a. Ultrasound b. Pulmonary angiography c. 12-lead ECG d. Ventilation and perfusion scan

b

Lilley Ch.26 pg. 434-435 3. The nurse is teaching a patient about self-administration of enoxaparin (Lovenox). Which statement will be included in this teaching session? a. "We will need to teach a family member how to five this drug in your arm." b. "This drug is given in the folds of your abdomen, but at least 2 inches away from your navel." c. "This drug needs to be taken at the same time every day with a full glass of water." d. "Be sure to massage the injection site thoroughly after giving the drug."

b

P. 409 1.A patient with a rapid, irregular heart rhythm is being treated in the emergency department with adenosine. During administration of this drug, the nurse will be prepared to monitor the patient for which effect? a. Nausea and vomiting b. Transitory asystole c. Muscle tetany d. Hypertension

b

P. 409 3. The nurse is assessing a patient who has been taking quinidine and asks about adverse effects. An adverse effect associated with the use of this drug includes: a. Muscle pain b. Tinnitus c. Chest pain d. Excessive thirst

b

17. A client comes to the emergency department with chest discomfort. Which action does the nurse perform first? a. Administers oxygen therapy b. Obtains the client's description of the chest discomfort c. Provides pain relief medication d. Remains calm and stays with the client

b A description of the chest discomfort must be obtained first, before further action can be taken. Neither oxygen therapy nor pain medication is the first priority in this situation; an assessment is needed first. Remaining calm and staying with the client are important, but are not matters of highest priority.

Question 3 of 24 A ventilated client in the intensive care unit (ICU) begins to pick at the bedcovers. Which action should the nurse take next? a. Increase the sedation. b. Assess for adequate oxygenation. c. Explain to the client that he has a tube in his throat to help him breathe. d. Request that the family leave to decrease the client's agitation.

b Assess for adequate oxygenation. Restlessness, agitation, anxiety, and tachycardia are early symptoms of hypoxemia. Increasing sedation is not indicated for this client and may mask symptoms such as hypoxemia or worsening respiratory failure. Although the nurse may explain to the client that he or she is intubated, it does not take priority over assessing for hypoxemia. The presence of family members may decrease the chances of "ICU psychosis" and anxiety, but it does not take priority over assessing for hypoxemia.

Evolve 4. To prevent the occurrence of cinchonism in a patient prescribed quinidine (Quindex), which instruction is MOST important for the nurse to provide for this patient? a. Increase dietary intake of potassium. b. Avoid drinking grapefruit juice. c. Advise the patient to wear sunscreen every day. d. Remind the patient to change positions slowly.

b Avoid drinking grapefruit juice. Grapefruit juice can inhibit the metabolism of quinidine, which increases the risk of cinchonism.

Rudd Ch.12 Pg.246-247 Review Questions 1. The Jones Criteria are used to diagnose which of the following? a. Septic shock b. Rheumatoid arthritis c. Systemic lupus erythematosus d. Bipolar disorders

b Rheumatoid arthritis

A patient with a diagnosis of heart failure has been started on a nitroglycerin patch by his primary care provider. What should this patient be taught to avoid? a. High-potassium foods b. Drugs to treat erectile dysfunction c. Nonsteroidal antiinflammatory drugs d. Over-the-counter H2 -receptor blockers

b. Drugs to treat erectile dysfunction The use of erectile drugs concurrent with nitrates creates a risk of severe hypotension and possibly death. High-potassium foods, NSAIDs, and H2-receptor blockers do not pose a risk in combination with nitrates.

What should the nurse recognize as an indication for the use of dopamine (Intropin) in the care of a patient with heart failure? a. Acute anxiety b. Hypotension and tachycardia c. Peripheral edema and weight gain d. Paroxysmal nocturnal dyspnea (PND)

b. Hypotension and tachycardia Dopamine is a β-adrenergic agonist whose inotropic action is used for treatment of severe heart failure accompanied by hemodynamic instability. Such a state may be indicated by tachycardia accompanied by hypotension. PND, anxiety, edema, and weight gain are common signs and symptoms of heart failure, but these do not necessarily warrant the use of dopamine.

The nurse is preparing to administer digoxin to a patient with heart failure. In preparation, laboratory results are reviewed with the following findings: sodium 139 mEq/L, potassium 5.6 mEq/L, chloride 103 mEq/L, and glucose 106 mg/dL. What should the nurse do next? a. Withhold the daily dose until the following day. b. Withhold the dose and report the potassium level. c. Give the digoxin with a salty snack, such as crackers. d. Give the digoxin with extra fluids to dilute the sodium level.

b. Withhold the dose and report the potassium level. The normal potassium level is 3.5 to 5.0 mEq/L. The patient is hyperkalemic, which makes the patient more prone to digoxin toxicity. For this reason, the nurse should withhold the dose and report the potassium level. The physician may order the digoxin to be given once the potassium level has been treated and decreases to within normal range.

escape beats

back up rhythm

rapid onset (can tell you exactly when throat started hurting) uvular edema

bacterial pharyngitis

studded follicles with pus how do you tx

bacterial pharyngitis PEN 10 days

can loos like maculopaplar rash strawberry tongue of scarlet fever

bacterial phayngitis

Early decelerations

begin prior to peak of contraction and end by the end of contraction. Caused by head compression. No need for intervention if variability is WNL

Beta adrenergic agents stimulate

beta 2 adrenergic receptors in smooth muscle of bronchi/ bronchioles.

Tx for PVcs

beta blockers check electrolytes

8. The S1 heart sound results from close of the _________ and tricuspid valves.

bicuspid (mitral) - AV valves (tricuspid and bicuspid)

Complications of PTCA may include

bleeding at the insertion site, abrupt closure of the artery, arterial thrombosis, and perforation of the artery

Left Sided HF

blood backs up into the left Atrium and then into the lungs

embolus

blood clot that breaks off from thrombus and circulates

thrombus

blood clot that forms somewhere in vessel

hypertension

blood pressure above normal range for age and gender

ischemic heart disease

blood supply to heart tissue is deficient and causes increase of lactic acid, leading to angina chest pain

s/s of digoxin toxicity

blurred vision nausea vomitting GI disturbance confusion decrease LOC

left ventricle pumps blood to the

body

Sealed radiation

body fluids NOT radioactive clients emit radiation

Coronary artery bypass graft

borrowed piece of blood vessel used to bypass a blocked artery in the heart

which ventricle pumps more blood

both pump the same amount of blood at the same rate (70 mL)

Thrombolytic

breaks down thrombus

Beta adrenergic agents lead to

bronchodilation

Singulair (montelukast)

bronchodilator for asthma

Anything increasing the blood flow velocity such as fever, anemia, hyperthyroidism, or physical exertion, can increase the amplitude of the

bruit

generated by turbulent flow of blood in an artery due to either an area of partial obstruction or a localized high rate of blood flow through an unobstructed artery.[4] The bruit may be heard auscultated by securely placing the head of a stethoscope to the skin over the turbulent flow, and listening. Most bruits occur only in systole, so the bruit is intermittent and its frequency dependent on the heart rate. Anything increasing the blood flow velocity such as fever, anemia, hyperthyroidism, or physical exertion, can increase the amplitude of the bruit.

bruit

how is heart rate determined on an ECG

by the number of squares a full wave covers; each square=0.2 seconds 3 squares=100 bpm 4 squares=75 bpm 6 squares=60 bpm

18. A patient has heart failure related to MI. What interventions does the nurse plan for this patient's care? a. Administering digoxin (Lanoxin) 1.0 mg as a loading dose and then daily b. Infusing IV fluids to maintain a urinary output of 60 mL/hr c. Titrating vasoactive drugs to maintain a sufficient cardiac output d. Observing for such complications as hypertension and flushed, hot skin

c

23. A patient is following up on a postoperative complication of PE. The patient must have blood drawn to determine the therapeutic range for Coumadin. Which lab test determines this therapeutic range? a. PTT level b. Platelets c. PT and INR d. Coumadin peak and trough

c

24. A patient is trying to make dietary modifications to reduce lipid levels. The patient would like information about omega-3 fatty acid food sources. What best source does the nurse recommend? a. Flaxseed b. Flaxseed oil c. Fish d. Walnuts

c

32. Which statement about silent MI is correct? a. In a silent MI, the patient does not have any pain, so there is less myocardial damage. b. Diabetic patients are prone to silent MI that goes undiagnosed without complications. c. Silent MI increases the incidence of new coronary events. d. In silent MI, the myocardium is oxygenated by increased collateral circulation.

c

Lilley Ch.26 pg. 434-435 2. A patient is receiving instructions regarding warfarin therapy and asks the nurse about what medications she can take for headaches. The nurse will tell her to avoid which type of medications? a. Opioids b. acetaminophen (Tylenol) c. NSAIDs d. There are no restrictions while taking warfarin.

c

Lilley Ch.26 pg. 434-435 4. A patient is receiving dabigatran (Pradaxa), 150 mg twice daily, as part of treatment for atrial fibrillation. Which condition, if present , would be a concern if the patient were to receive this dose? a. Asthma b. Elevated liver enzymes c. Renal Impairment d. History of myocardial infarction

c

P. 409 2.When assessing a patient who has been taking amiodarone for 6 months, the nurse monitors for which potential adverse effect? a. Hyperglycemia b. Dysphagia c. Photophobia d. Urticaria

c

P. 409 4. A patient calls the family practice office to report that he has seen his pills in his stools when he has a bowel movement. How will the nurse respond? a. "The pills are not being digested properly. You need to take them on an empty stomach." b. "The pills are not being digested properly. You need to take them with food." c. "What you are seeing is the wax matrix that contained the medication, but the drug has been absorbed." d. "This indicates that you are not tolerating this medication and will need to switch to a different form."

c

P. 409 8. A patient is in the clinic for a follow-up visit. He has been taking amiodarone (Cordarone) for almost 1 year, and today he tells the nurse, "I am noticing some blue color around my face, neck, and upper arms. Is that normal?" Which is the nurse's correct response? a. "This is an expected side effect and should go away soon." b. "This is a harmless effect. As long as the medication is working, we'll just monitor your skin. c. "This can happen with amiodarone. I will let your doctor know about it right away." d. "How many sun exposures have you had recently?"

c

Evolve 5. The nurse understands adenosine (Adenocard) is used to treat which condition? a. Atrial fibrillation b. Second-degree atrioventricular block c. Paroxysmal supraventricular tachycardia (PSVT) d. Atrial flutter

c Paroxysmal supraventricular tachycardia (PSVT) The only therapeutic indication of use for adenosine is the treatment of PSVT.

Rudd Ch.12 Pg.246-247 Review Questions 4. Primary or essential hypertension is suggested when the blood pressure is a. <90th percentile b. <50th percentile c. between 95th percentile and 5 mm Hg above 99th percentile d. >99th percentile plus 5 mm Hg

c between 95th percentile and 5 mm Hg above 99th percentile

Rudd Ch.12 Pg.246-247 Review Questions 2. The nurse responds to the child's monitor alarm, which sounded this morning. When the nurse views the ECG, it shows a heart rate of 240 beats/minute. The nurse verifies that this rate is correct. This ECG indicates A. bradycardia b. tachycardia c. supraventricular tachycardia d.second-degree heart block

c supraventricular tachycardia

You are caring for a patient with ADHF who is receiving IV dobutamine (Dobutrex). You know that this drug is ordered because it (select all that apply): a. incerases SVR b. produces diuresis c. improves contractility d. dilates renal blood vessels e. works on the B1-receptors in the heart.

c & e Rationale: Dobutamine (Dobutrex) has a positive chronotropic effect and increases heart rate and improves contractility. It is a selective β-adrenergic agonist and works primarily on the β1-adrenergic receptors in the heart. It is frequently used in the short-term management of acute decompensated heart failure (ADHF).

Which sign or symptom suggests that a client's abdominal aortic aneurysm is extending? a) Elevated blood pressure and rapid respirations b) Decreased pulse rate and blood pressure c) Increased abdominal and back pain d) Retrosternal back pain radiating to the left arm

c) Increased abdominal and back pain Explanation: Pain in the abdomen and back signify that the aneurysm is pressing downward on the lumbar nerve root and is causing more pain. The pulse rate would increase with aneurysm extension. Chest pain radiating down the arm would indicate myocardial infarction. Blood pressure would decrease with aneurysm extension, and the respiratory rate may not be affected.

Which of the following is the most common site for a dissecting aneurysm? a) Cervical area b) Sacral area c) Thoracic area d) Lumbar area

c) Thoracic area Explanation: The thoracic area is the most common site for a dissecting aneurysm. About one-third of patients with thoracic aneurysms die of rupture of the aneurysm.

When assessing the cardiovascular system of a 79-year-old patient, you might expect to find a. a narrowed pulse deficit b. diminished carotid artery pulses c. difficulty in isolating the apical pulse. d. an increased heart rate in response to stress

c. difficulty in isolating the apical pulse.

A patient with a tricuspid valve disorder will have impaired blood flow between the a. vena cava and right atrium b. left atrium and left ventricle c. right atrium and right ventricle d. right ventricle and pulmonary artery

c. right atrium and right ventricle

Reduces hearts workload by decreasing heart rate and myocardial contraction

ca+ channel blockers

decreases heart rate and myocardial contraction decreasing heart workload

ca+ channel blockers

cardiac surgery requires

cardiopulmonary bypass

angioplasty

catheter is directed down a blocked vessel to a narrow area and widened by a balloon to stretch open that area

secondary hypertension

caused by another known disease process

common in ppl who habitually use alcohol and tobacco

chronic pharygitis

Plasminogen

converting enzyme for plasmin

CAR stands for

coronary artery revascularization

2 PVCs in a row

couplet

vesicles on hand food mouth

coxsackie viral pharyngitis

23. Which early reaction is most common in patients with the chest discomfort associated with unstable angina or MI? a. Depression b. Anger c. Fear d. Denial

d

Lilley Ch.26 pg. 434-435 1. The nurse is monitoring a patient who is receiving anti-thrombolytic therapy in the emergency department because of a possible MI. Which adverse effect would be of the greatest concern at this time? a. Dizziness b. Blood pressure of 130/98 mm Hg c. Slight bloody oozing from the IV insertion site d. Irregular heart rhythm

d

P. 409 5. The nurse is administering lidocaine and considers which condition, if present in the patient, a caution for the use of this drug? a. Tachycardia b. Hypertension c. Ventricular dysrhythmias d. Renal dysfunction

d

18. Which statement by a client scheduled for a percutaneous transluminal coronary angioplasty (PTCA) indicates a need for further preoperative teaching? a. "I will be awake during this procedure." b. "I will have a balloon in my artery to widen it." c. "I must lie still after the procedure." d. "My angina will be gone for good."

d Reocclusion is possible after PTCA. The client is typically awake, but drowsy, during this procedure. PTCA uses a balloon to widen the artery, and the client will have to lie still after the procedure because of the large-bore venous access. Time is necessary to allow the hole to heal and prevent hemorrhage.

Rudd Ch.12 Pg.246-247 Review Questions 3. Transposition of the great vessels involves which of the following structures? a. pulmonary veins and pulmonary artery b. aorta and pulmonary veins c. inferior vena cava and superior vena cava d. aorta and pulmonary artery

d aorta and pulmonary artery

A home health nurse is seeing an elderly male client for the first time. During the physical assessment of the skin on the lower legs, the nurse notes edema, brown pigmentation in the gater area, pedal pulses, and a few irregularly shaped ulcers around the ankles. From these findings, the nurse knows that the client has a problem with peripheral circulation. Which of the following does the nurse suspect? a) Trauma b) Arterial insufficiency c) Neither venous nor arterial insufficiency d) Venous insufficiency

d) Venous insufficiency Explanation: Symptoms of venous insufficiency include present pedal pulses, edema, pigmentation in gater area, and a reddish blue color. Ulcers caused by venous insufficiency will be irregular in shape and usually located around the ankles or the anterior tibial area. Characteristics of arterial insufficiency ulcers include location at the tips of the toes, great pain, and circular shape with a pale to black ulcer base.

After having an MI, the nurse notes the patient has jugular venous distention, gained weight, developed peripheral edema, and has a heart rate of 108/minute. What should the nurse suspect is happening? a. ADHF b. Chronic HF c. Left-sided HF d. Right-sided HF

d. Right-sided HF An MI is a primary cause of heart failure. The jugular venous distention, weight gain, peripheral edema, and increased heart rate are manifestations of right-sided heart failure.

Beta Blockers

decrease heart rate and dilate arteries by blocking beta receptors

hv replacement surgery = replacement of how many types?

diseased hvr w/ artificial hv. 2 types of hvr = artificial valves: a mechanical hv made of artificial materials & can usually last a lifetime; biological hv are made from hv taken from animals or humans and can wear out over time.

peritonsillar risk

drainage and aspiration

50. When fluid filtered out of the capillaries exceeds the amount reabsorbed, accumulating interstitial fluid results in a condition known as _____.

edema

what allows arteries to stretch and recoil

elastin

ECG indicator of MI

elevated ST

how is myocardial infarction diagnosed

elevated levels of CPK and lactate dehydrogenase troponin in blood (6 hrs)

red raised plaques

erthmaplakia

Cachexia

extreme wasting and malnutrition

45. (True/False) Arterial insufficiency is characterized by altered skin pigmentation in the gaiter area.

false

leaking clear nasal liquid from either nostril indicates

fx of cribiform plate leaking cerebrospinal fluid

fenestrated capillaries

have wide intracellular pores present in kidneys & endocrine glands

causes of edema

high BP venous obstruction leakage of plasma proteins myxedema: excessive production of glycoproteins from hypothyroidism low plasma protein levels liver disease obstruction of lymphatic drainage pregnancy

symptom most closely associated with early stages of laryngeal cancer?

hoarseness

Albumin

holds fluid in vascular space

Starling forces

hydrostatic pressure in capillary + colloid osmotic pressure of interstitial fluid (fluid out) - hydrostatic pressure of interstitial fluid + colloid osmotic pressure of blood plasma (fluid in)

asoscaited w/ smoking and or ETOH abuse PREMALIGNANT!!

hyperkeratosis

Preload is increased by what factors?

hypervolemia regurgitation of cardiac valves

Heart block poem

if the R is far from P --Then you have a first degree longer, longer, longer, drop! --then you have a wenkebach if some p's just don't go through --then you have a mobitz two if p's and q's just don't agree --then you have a third degree

what do lymph nodes contain

immune cells

What does a prolonged PR Interval mean?

impulse pausing in AV node

where is the majority of the blood at rest

in the veins (70%)

cardiogenic shock

inadequate pumping of the heart often due to MI

following mechanisms in heart failure lead to

inappropriate fluid retention and additional workload of the heart: activation of the renin-angiotensin-aldosterone system (RAAS) cascade and release of antidiuretic hormone from the posterior pituitary gland in response to low cerebral perfusion pressure that results from low cardiac output.

primary (essential) hypertension

increased PR, CO, HR high stress and high salt intake prolonged can lead to arteriosclerosis

water retention promotes

increased fluid volume/ BP

septic shock

infection of G- bacteria LPS causes excess production of NO and vasodilation

Etiology of PJCs

inschemia insult to AV junction hypoxemia valvular disease DIGITALIS toxicity!

if epistasis cont. even after head tilt/ applied pressure to nasal septum NI to be implemented is

insertion of cotton tampon into affected nare can be use to stop bleeding

fibrin

insoluble protein formed from plasma protein fibrinogen during clotting and forms a fibrous mesh that impedes the flow of blood.

metabolic syndrome

insulin resistance abdominal obesity (waist circumference>40) increased triglycerides decreased HDL increased BP CAD

Na+ & K+ have

inverse relationship

von willenbrands disease

lack of V.W. factor

head between legs when

lacking cerebral perfusion

An output of ___ may indicate hypovolemia or renal insufficiency

less than 1 mL/kg/h

Clinical signs and sx of vfib

loss of consciousness no pulse no respirations no blood pressure cyanosis death

Desired/ norm Lipoprotein in body

low LDL High HDL

sodium

mEq/dL 135-145

Overuse of nasal spray

may cause rebound of nasal congestion

mvr abv as

mechanical valve replacement

49. The amount of blood flow needed by individual organs and tissues is determined by ____ requirements.

metabolic

Calcium

mg/L 8.5-10.5

Intercostal retractions are mild, moderate, or severe distress?

mild distress

mmHg stands for

millimeters of mercury

MODS

multiple organ dysfunction syndrome

Nursing considerations for Cardiac Glycosides

must be held if HR less than 60 Daily weights Hypokalemia

Polarized cell (resting cell) = more _________ inside than outside

negative

Schedule 4

new prescription q 6 months

second degree AV node block

only one out of the 2-4 atrial APs pass to ventricles no QRS wave

sheath will be placed when and where?

over PCI insertion site after procedure is finished.

thrill

palpable vibration on CW accompanying severe heart murmur

should immediately receive supplemental oxygen, aspirin, nitroglycerin, and morphine.

patient with suspected MI

bacterial infection of the tonsils that may spread to soft palate

quinsy

usually a complication of tonsillitis

quinsy

usually a complication of tonsillitis, a bacterial infection of the tonsils and may spread to soft palate

quinsy

anaphylactic shock

rapid fall in BP due to release of histamine from severe allergic reaction

The patient with suspected MI should immediately receive supplemental oxygen, aspirin, nitroglycerin, and morphine. Morphine sulphate...

reduces preload and decreases workload of the heart

Morphine sulphate

reduces preload/ workload of the heart

ANP/BNP

released in response to increased blood volume in heart Causes Vasodilation and lowers BP Stops SNS stimulation of RAAS

normal BP stops

renin

Clinical signs and symptoms of PJCs

seldom produces sx patient may have irregular pulse

Adrenals help you handle

stress

40. Diuretics are most effective if the patient assumes a ____ position for 1 to 2 hours after taking them.

supine

how can CO increase

sympathetic activation increased venous return

how can you detect ischemic heart disease on and ECG

the ST segment gets depressed or elevated

where are nutrients and waste products exchanged

the capillaries

what are the symptoms of hypertension

there are none until vascular damage occurs ventricular hypertrophy congestive heart failure stroke

how do gases pass through capillaries

they diffuse

tonic muscles of mastication term

trismus

T or F Most respiratory problems in children produce mild symptoms, last a short time and can be managed at home.

true

High Flow Oxygen Systems - Aerosol Mask

used when high humidity is needed after extubation or upper airway surgery or for thick secretions

*Pediatric Upper Airway* -Newborns are ______ breathers until at least 4 weeks of age -Nasal patency in newborn essential for _______ and ________.

-Newborns are *nose breathers* until at least 4 weeks of age (1-30 days old) -Nasal patency in newborn essential for *breathing and eating*

RBC

4.2 to 6.2 mill

Gentamicin Peak:

5-10 mcg/mL Trough: <2 mcg/mL

Normal BUN

7-22

Child (2-6yrs) vital signs

98.6F (T) HR: 90-110 BP: 85/60 - 100/70 Resp: 20-30

Brief periods of apnea is <_____-____seconds.

< 10-15 seconds

urine c & s

< 100000

Troponon I normal range/value:

<0.3

time of QT interval

<0.38 seconds

Normal Bilirubin

<1.0

Antidote for Tricyclic anti-depressants

Sodium Bicarbonate

pH DOWN // CO2 N // HCO3 DOWN

uncompensated metabolic acidosis

pH UP // CO2 N // HCO3 UP

uncompensated metabolic alkalosis

pH DOWN // CO2 UP // HCO3 N

uncompensated respiratory acidosis

pH UP // CO2 DOWN // HCO3 N

uncompensated respiratory alkalosis

unstable angina

unstable angina

Low Flow Oxygen Systems - Nasal Cannula or Prongs

used at rates 1-6 L/min; O2 concentration of 24% (1L)- 44% (6L); greater than 6 does not increase oxygenation because of anatomic dead space; often used for chronic lung disease and for and pt needing long-term oxygen therapy

What is percussion used for?

used to assess resonance of lungs and underlying organs (we don't do this though, because we would know this by chest xray)

Low Flow Oxygen Systems - Simple Facemask

used to deliver O2 concentrations of 40-60% for short-term oxygen therapy or in emergency; min flow of 5 L/min is needed to prevent rebreathing of exhaled air; care for skin under mask and strap to prevent skin breakdown

High Flow Oxygen Systems - Tracheostomy Collar

used to deliver high humidity and the desired oxygen to the pt with tracheostomy

extremes in blood sugar cause

vascular damage

FALSELY assumed exercise causes

vasoconstriction

what occurs in skeletal muscle you aren't using

vasoconstriction lower CO2 cold

Epinephrine

vasoconstrictor

what occurs in skeletal muscles you are using

vasodilation decreased O2 increased CO2 heat

where are action potentials from baroreceptors sent

vasomotor and cardiac control centers in the medulla

which vessels have the lowest pressure

veins leading directly to the heart

na+ retention promotes

water retention

in MVS due to Afib the pulse is often

weak and irregular

in mvs the pulse is characterized as ? why?

weak and often irregular bc afib

Atypical angina symptoms

weakness or shortness of breath on exertion without chest pain

pancreatic amylase

digests starch

DMARD

disease-modifying antirheumatic drug

In Systolic HF the LV loses ability to generate enough pressure to eject blood forward through the aorta resulting in

elevated PAWP

how are lymphatic vessels different than other vessels

endothelial cells overlap each other to create a one-way valve

capillaries are made of only

endothelium

Enlarged P wave =

enlarged atria

Adrenal medulla

epinephrine & norepinephrine

angioedema = hereditary condition which concludes

episodes of life threatening laryngeal edema = airway obstruction

what is the transport of HDLs

from the tissues to liver

voice abuse and smoking white raised plaques PREMALIGNANT

leukoplakia

which substances pass through the endothelial cells of capillaries

lipid soluble substances

hypovolemic shock

low blood volume

During tactile fremitus you feel increased sensations, what does this indicate?

lung consolidation (EX: pneumonia)

48. ____ vessels transport fluid from the interstitial space to systemic veins.

lymphatic

unilateral tonsillitis can be

lymphoma

PRemature beats

occur early

rhinoviruess invade the nasal epithelium which in turn

produces pharyngeal irriation

tonic contraction is characterized by

prolonged maintenance of tension in muscles of mastication

Isolation with burn client

protective

which substances pass through the pores of capillaries

small water soluble substances

nonpharmacologic treatment of HTN

smoking cessation moderation of alcohol weight reduction exercise reduced sodium intake increased potassium intake

Bronchi and bronchioles are lined with who?

smooth muscle

tunica media

smooth muscle & elastin

the back of the roof of the mouth

soft pallate

High Flow Oxygen Systems - T-Piece

special adaptor used to deliver any desired FiO2 to pt with tracheostomy, laryngectomy, or endotracheal tube

chest pain occurring when person is active or under severe stress

stable angina

result of ischemia that is initiated by increased demand (activity) relieved w/ rest/ reduction of demand

stable angina

juxatolomerluar cells secrete renin which

stimulates angiotensin II production.

how do E & NE produce a positive inotropic effect

stop activity of NCX channels so that calcium goes back into the SR

If extravasation happens

stop infusion cold packs call HCP

Tetanus toxoid

Active immunity *takes 2-4 weeks to develop immunity)

ST Segment Elevation

Acute myocardial injury, preinfarction, & pericarditis

this condition is due to HPV serotypes 6 and 11

Laryngeal papillomatosis

GTT 2 hours

Less than 140 mg/dL

serum albumin

Used to detect protein malnutrition *g/dL* 3.5-5.5

receptors during sympathetic NS

alpha receptors constrict beta receptors dilate

receptors during parasympathetic NS

alpha receptors dilate beta receptors constrict

discontinuous capillaries

large and leaky gaps present in liver, spleen, & bone marrow

Cholesterol levels

Less than 200 = Normal 200 to 239 Borderline High Greater than 240 = High risk

Unsealed internal radiation

client & body fluid emit radiation for 24-48 hours

Vitamin A foods

colored veggies

the total daily dose of insulin with basal/bolus method is

combo of long acting and rapid acting

part between the P wave and the Q

PTa

ECG s/o pericarditis or atrial MI

PTa depression

Glucocorticoids

Prednisone betamethasone dexamethasone cortisone hydrocortisone methylprednisone tramcinolone

unstable angina

chest pain that occurs while a person is at rest and not exerting himself

common in people use their voice excessively

common pharyngitis

pH Low N // CO2 UP // HCO3 N

compensated respiratory acidosis

total laryngectomy

complete removal of the larynx

Extrensic Pathway

completed in seconds triggered by injury outside of vessel

Thromboembolic Disorder

condition that predisposed a person to formation of clots and emboli

tunica externa

connective tissue

manifestations of systolic failure

decreased EF and increased PAWP

Norvasc does what

decreases he

Preload

degree of stretch of cardiac muscle fibers at the end of diastole

caused by HPV in young children common in immigrant pop

laryngeal papillomatosis = causes hoarseness

humidification system post op

laryngectomy

diffuse edema erythema and vascular engorgement of vocal folds

laryngitis

hoarseness dysphonia maybe pain if > 22 wks refer

laryngitis

what leads give you a frontal view of the heart

lead I, lead II, lead III, and aVF, aVR, aVL

indicative of fx to cribriform plate

leaking clear nasal liquid/ cerebrospinal fluid from either nare

which side of the heart is more muscular

left

pulmonary veins bring oxygenated blood back to the

left atrium

PCI NI

sheath over PCI access site til adequate coagulation is achieved prophylactic anticoagulants activity resumes few hrs s/p PCI

Hypotonic solutions

shift out into cells to replace cellular fluid 1/2 NS 0.33%NS *watch for cellular edema*

what factors aide in venous return

skeletal muscle pump respiratory pump

vesicant

type of chemo that if infiltration occurs will cause tissue necrosis *stay with them the entire time*

CVP

3-12

The nurse is assessing a 62-year-old woman undergoing radiation treatment for breast cancer. How should the nurse position the patient to auscultate for signs of acute pericarditis? A. Supine without a pillow B. Sitting and leaning forward C. Left lateral sidelying position D. Head of bed at a 45-degree angle

B. A pericardial friction rub indicates pericariditis. To auscultate a pericardial friction rub, the patient should be sitting and leaning forward. The nurse will hear the pericardial friction rub at the end of expiration.

*Room air is what percentage of oxygen?* a. 16 % b. 21 % c. 20 % d. 22 %

B. 21 %

^ triglycerides = major risk for

CVD

Which instruction given to a patient who is about to undergo Holter monitoring is most appropriate? A. "You may remove the monitor only to shower or bathe." B. "You should connect the monitor whenever you feel symptoms." C. "You should refrain from exercising while wearing this monitor." D. "You will need to keep a diary of all your activities and symptoms."

D. A Holter monitor is worn continuously for at least 24 hours while a patient continues with usual activity and keeps a diary of activities and symptoms. The patient should not take a bath or shower while wearing this monitor.

The blood pressure of a 71-year-old patient admitted with pneumonia is 160/70 mm Hg. What is an age-related change that contributes to this finding? A. Stenosis of the heart valves B. Decreased adrenergic sensitivity C. Increased parasympathetic activity D. Loss of elasticity in arterial vessels

D. An age-related change that increases the risk of systolic hypertension is a loss of elasticity in the arterial walls. Because of the increasing resistance to flow, pressure is increased within the blood vessel, and hypertension results. Valvular rigidity of aging causes murmurs, and decreased adrenergic sensitivity slows the heart rate. Blood pressure is not raised. Increased parasympathetic activity would slow the heart rate.

Etiology of 3rd degree Complete Heart Block

Insult to AV node Acute MI cardiac drugs

PAOP AKA

PAWD

Decompensated LHF

Pulmonary Edema

Hemostatis

Stop of blood flow

Alteplase

Thrombolytic Agent

Sinustop Pro and Afrin are both an

pseudoephedrine

lockjaw

trismus

Aldosterone causes what?

↑ Na reabsorption ↑ K secretion ↑ H+ secretion Aldosterone stimulates the secretion of K+ into the tubular lumen. Aldosterone stimulates Na+ and water reabsorption from the gut, salivary and sweat glands in exchange for K+. Aldosterone stimulates secretion of H+

21. The nurse is giving a community presentation about heart disease. Because many sudden cardiac arrest victims die of ventricular fibrillation before reaching the hospital, which teaching point does the nurse emphasize? a. Controlling alcohol consumption and quitting cigarette smoking b. Modifying risk factors such as diet and weight, and blood pressure medication compliance c. Recognizing the difference between chronic stable angina and unstable angina d. Learning to operate the automatic external defibrillators (AEDs) in the workplace

d

To prevent venous thromboembolism, patients should avoid

crossing the legs, place pillow under popliteal space. Compression stockings as prophylaxis not when s/s emerge.

most common death of all pops in us

cvd

tunica interna

endothelium

TX: self limiting thoart spray warm salt water gargles give max dose of Ibuprofen and give tylenol: alternate btwn the both

for adenovirus pharyngitis

Bruit vs Thrill

hear the bruit, feel the thrill

heart flutter

heart beats 200-300 bpm but the heart is still pumping blood

Systolic HF

heart can't contract and eject

heart fibrillation

heart cells depolarize asynchronously and does not pump blood

what creates hydrostatic pressure in vessels

heart contractions

hypertrophic cardiomyopathy

heart muscle becomes enlarged and blocks blood flow

what four things can an ECG tell you

heart rate arrhythmias myopathies-damage to heart wall damage to conduction system-cells

what controls blood pressure

heart rate stroke volume peripheral resistance increased cardiac output kidneys

Automaticity

heart/ myocardial cells ability to contract/ generate/ conduct electrical impulses on its own w/o stimulation from NS

Hip fx complication

hemorrhage

potential post op complication tonsillectomy

hemorrhage

Clinical signs and symptoms of atrial fibrillation

irregular pulse pulse deficit(difference radial vs apical) may experience palpitations, angina, dyspnea Possible emboli!!!!

Slinical Signs and Sx of Sinus Arhythmia

irregular pulse, usually asymptomatic

Clinical signs and sx of PACs

irregullar pulse patient unaware of PACs

what creates colloid osmotic pressure in capillaries

large proteins trapped in the blood stream that do not enter the interstitial space

causes hoarseness

laryngeal papillomatosis

Hypertrophic Cardiomyopathy (HCM)

leading cause of sudden death in athletes; involves an abnormally enlarged left ventricle

A young pt. w/ a family hx of sudden death collapses and dies while exercising.

HCM

___ promotes the use of total cholesterol by transporting ___ to the liver, where it is excreted

HDL LDL

What does increased BNP indicate?

HF if level is above 100

Tx for sickle cell crisis

HHOP heat, hydration, oxygen, pain management

Risk factors for Heart Failure

HPT and CAD Contributing risk factors: Increased Age Diabetes Tobacco Use Obesity High Serum Cholesterol

Laryngeal papillomatosis is due to

HPV serotypes 6 and 11

Clinical signs and sx of 3rd degree AV bock

HR very slow drop in CO may progress to ventricular standstill LETHAL DYSRYTHMIA

in ___ the pulse is weak and often irregular because of afin.

MVS

high PAWP (pulmonary artery wedge/ occlusive pressure)

left ventricle failure, mitral valve pathology, cardiac insufficiency, cardiac compression post hemorrhage.

pawp elevation indicates

left ventricle failure, mitral valve pathology, cardiac insufficiency, cardiac compression post hemorrhage. CI, CC s/p hemorrhage LVF MVP

What is the ejection fraction of Systolic HF?

less than 45%

When you see K+ think

life threatening arrhythmias (and muscle twitching)

T Lymphocytes and monocytes infiltrate

lipids at arterial wall

intially invovles/infects B lymphocytes of pharynx --> dissemination --> replication in the

lymphoreticular system-->immune respone (heterophile antibodies) EBV mon pharyngitis

potassium

mEq/dL 3.5-5

Physical exertion increases the myocardial oxygen demand

myocardial o2 demand

cardiopulmonary bypass

oxygenates/ circulates blood while bypassing lungs/ heart keeping surgical field free from blood

CPB

oxygenating Heart and lung pump machine

Hypertonic (colloid) solutions

packed with parties draw fluid into vascular space from cells given n ICU setting 3% NS 5% NS

Intermittant Claudication

pain or crampingin legs that worsens with walking

deviation of the uvula with swelling may be a strong indication of

parapharangeal abcess or peritonsillar abcess

39. The term ____ noctural dyspnea refers to sudden attacks of shortness of breath occurring at night.

paroxysmal

Clinical signs and sx of PVCs

patient complaint of palpitations/skipped beats may lead to Vtach or Vfib

post op mvr pt. teaching = atbx prophylactically for

pre inv dental op manipulating gingiv tissue, periapical area of teeth or when perforating oral mucosa

end diastolic/ fill of blood volume in ventricles + cardiac muscle fibers degree of stretch as the volume of blood builds up.. The pre contraction pressure/ degree of stretch of cardiac muscle fibers in the heart as the volume of blood builds up.

preload

what determines stroke volume

preload (EDV) after load (TPR) contractility

3 factors that govern stroke volume

preload, contractility, afterload

Clinical signs and sx of sinus tachycardia

rapid regular pulse may sense palpitations may experience dyspnea may be asymptomatic

Clinical sign and symptoms of PSVT

rapid regular pulse signs and symptoms of decreased cardiac output

If trach comes out, first action is to

re-establish airway

where do lymph vessels originate

the capillary beds

what activity is seen on an ECG

the depolarization and repolarization of contracting cells

Urine specific gravity

1.010 - 1.030

ventricles push blood out into the

arteries

good marker for future cardiovascular events.

Baseline hs-CRP

beta-adrenergic receptors are found where?

Bronchioles, heart, liver. cause increase in metabolism

Alka seltzer, Fleet's, & IVF with Na all have a lot of

Na

ischemic damage to myocardium.

T wave inversion

3 hormones thyroid gland produces

T3 T4 Calcitonin

Trough level is drawn

after the 3rd dose, before the 4th

During tactile fremitus you feel decreased sensations, what does this indicate?

air trapped in lungs (EX: asthma)

what is an ECG

an electrical recording of the heart

which vessels have the highest pressure

arteries leading away from the heart

common in ppl who work in dusty surroundings

common pharyngitis

Why is a pediatric airway at greater potential/risk for obstruction?

Airway shorter and more narrow

PVD symptoms

-Narrowed arteries / veins reducing blood flow to limbs. -A sign of a more widespread accumulation of fatty deposits in your arteries (atherosclerosis).

LDL

Determines whether elevated cholesterol levels are caused by increased LDL or HDL *Fast for 12-14 hours* *mg/dL* <160 if no CAD

HDL

Determines whether elevated cholesterol levels are caused by increased LDL or HDL *mg/dL* 35-85 (W) 35-70 (M)

PTT

*monitors effectiveness of heparin therapy **detects coagulation disorders 20-39 sec. normal Lower limit of normal: 20-25 sec Upper limit of normal: 32-39 sec 1.5-2.5x = therapeutic

16. Hypertension, as defined by the JNC 7, is a systolic and diastolic blood pressure greater than _______/_______ mm Hg based on the average of two or more accurate blood pressure measurements.

140/90

*When using Stethoscope:* -Close fitting _______. -Deep breaths through _______. -You can listen while ________. -Always under ________.

-Close fitting *seal* (get underneath clothes) -Deep breaths through *mouth* -You can listen while *sleeping* -Always under *clothes*

Respiratory Assessment

*-Pulse oximetry* (many on continuous) *-Cardiac respiratory monitor* (many on cardiac/resp monitor) *-Change in muscle tone* *-Behavior* (if good behavior than probably not having resp distress; agitated-lethargy as hypoxia progresses) *-Color* (pink>pale>gray>cyanosis) *-Level of Consciousness*

Regular insulin

"R" only one given IV clear peaks in 3-6 hours

Rapid acting insulin

"logs" never give without food at bedside given before meals in bolus doses to cover food eaten at meals Only insulin that can be given on pump Peaks in 30 min

Aldosterone

"salt-retaining hormone" which promotes the retention of Na+ by the kidneys. na+ retention promotes water retention, which promotes a higher blood volume and pressure

platelet count reflects the number of circulating platelets in venous or arterial blood.

# of circulating platelets in venous or arterial blood

Sedimentation rate ESR

**indicates inflammation -speed at which RBCs settle in well-mixed venous blood *mm/h* 0-2 (N) > 10 (C) <25 (<50 F) <30 (>50 F) <15 (<50 M) <20 (>50 M)

INR

**monitors effectiveness of anticoagulation therapy 1.0 normal 2-3.5 therapeutic 2-3 (a.fib, DVT, PE therapeutic levels) 2.5-3.5 (prosthetic heart valves therapeutic)

*Respiratory Assessment r/t infections rate: which is higher/lower infection AND EXPLAIN* -< 3 months: -3-6 months: -Toddler/preschool years:

*-< 3 months:* lower infection rate due to protective function of maternal antibodies *-3-6 months:* Infection rate increases due to disappearance of maternal antibodies and initiation of the production of the infants' own antibodies. *-Toddler/preschool years:* viral infection rate high

*Retractions-match each below: Substernal, Suprasternal, Supraclavicular, subcostal, Intercostals* -between ribs -above the sternum -below sternum -above the clavicles -below the ribs

*-Intercostals:* between ribs *-Suprasternal:* above the sternum *-Substernal:* below sternum *-Supraclavicular:* above the clavicles *-Subcostal:* below ribs

*Vocal Resonance<NOT TESTED ON THIS * -Whispered pectoriloquy: syllables heard in a whisper -Bronchophony: sounds increased in intensity and clarity; words remain indistinct -Egophony:"eee" sound is trasnmitted as a nasal "ay "

*-Whispered pectoriloquy:* syllables heard in a whisper *-Bronchophony:* sounds increased in intensity and clarity; words remain indistinct *-Egophony:* "eee" sound is trasnmitted as a nasal "ay " (done by xray now)

Normal PR interval duration

*.12- 0.20 sec (less than one large box)*

Normal QRS interval duration

*0.06 - 0.12 sec (1-2 small boxes)*

Normal QT interval duration

*450 ms in men, 460 ms in women* Based on sex / heart rate Half the R-R interval with normal HR

Normal Sinus Rhythm

*All complexes normal* *Evenly spaced* *Rate 60 - 100/min*

Sinus Bradycardia

*All complexes normal* *Evenly spaced* *Rate <60/min*

Sinus Tachycardia

*All complexes normal* *Evenly spaced* *Rate >100/min*

*Cardiac arrest in the pediatric population is most often a result of?* A. atherosclerosis B. congenital heart disease C. prolonged hypoxia D. undiagnosed cardiac conditions

*C. prolonged hypoxia* (We can prevent cardiac arrest with assessment)

Atrioventricular Node (AV): Does what??

*Connects atria and ventricles* *delays impulses, it ensures that the atria have ejected their blood into the ventricles first before the ventricles contract* *40-60 beats/min*

Pulseless Electrical Activity: PEA These possible causes are remembered as the 6 Hs and the 6 Ts.

*H's and T's* Hypovolemia Hypoxia Hydrogen ions (Acidosis) Hyperkalemia or Hypokalemia Hypoglycemia Hypothermia Tablets or Toxins (Drug overdose) Cardiac Tamponade Tension pneumothorax Thrombosis (Myocardial infarction)(Pulmonary embolism) Tachycardia Trauma (Hypovolemia from blood loss)

Contractility

*Is the ability of muscle cells to contract after depolarization* Overstretching or understretching alters contractility and amount of blood pumped out of the ventricles.

What is an ECG?

*Measures electrical potential* *Does not measure muscle contraction* Is the process of recording the electrical activity of the heart over a period of time using electrodes placed on a patient's body. These *electrodes detect* the tiny *electrical changes* on the skin that arise *from the heart muscle depolarizing* during each heartbeat

Type 2 Second-degree AV block, Mobitz II

*PR fixed, but drop QRS randomly* Characterized by intermittently non-conducted P waves not preceded by PR prolongation and not followed by PR shortening. There is usually a fixed number of non-conducted P waves for every successfully conducted QRS complex

Type 1 - Second degree block, Mobitz type 1, Wenckebach

*PR gradually lengthened, then drop QRS* Characterized by progressive prolongation of the PR interval followed by a blocked P wave (i.e., a 'dropped' QRS complex). After the dropped QRS complex, the PR interval resets and the cycle repeats.

Preload

*Volume coming into ventricles (end diastolic pressure)*Is the stretching of the muscle fibers in the ventricles and is determined by the pressure and amount of blood remaining in the left ventricle at the end of diastole (The volume of blood stretching the left ventricle at the end of diastole)

P wave =

*atrial depolarization* First component of the ECG Normal P wave: Precedes the QRS complex *2 to 3 mm high* *.06 to . 12 seconds* Usually rounded and upright

WBC, leukocytes

*mm3* 9,000-30,000 (N) 5,000-13,000 (C) 5,000-10,000 (A)

PT

*monitor effectiveness of Coumadin ** detects coagulation disorders 9.5-12 sec normal 1.5-2.5x = therapeutic

total cholesterol

*evaluates tendency for athersclerosis **Overnight fast *mg/dL* 150-200

*Diminished or Absent Breath sounds* -what 4 things interfere with the conduction of breath sounds?

*fluid, air, solid masses or bronchoconstriction* interfere with the conduction of breath sounds

Hemoglobin

*g/dL* 14-24 (N) 11-12.5 (C) (3-12) 12-16 (W) 13-18 (M)

Bleeding time

*measures duration of bleeding after standardized skin incision ** used for preop screening *minutes* 1.5-9.5 min

RBC

*million/mm3* 4.8-7.1 (N) 3.5-5.2 (C) 4.2-5.4 (W) 4.6-6.2 (M)

Cardiac cells at rest are considered...?

*polarized*, meaning no electrical activity takes place

Can you shock Asystole?

NO! cant shock somehthing from nothing!

Mg & Ca

*think muscles first* they act like sedatives

RAAS

*this mechanism helps maintain a balance of sodium and water and a healthy blood volume and pressure. *When the fluid or sodium level falls, juxatolomerluar cells secrete renin, which stimulates angiotensin II production. *Angiotension II causes vasconstriction and stimulates aldosterone production. *Aldosterone causes sodium and water retention, leading to increased fluid and sodium levels. *when BP is returns to normal the body halts the release of renin, which stops the RASS system.

HCM tx

- Diuretics (furosemide) - Beta blockers: propanolol, aten/ propanolol - Calcium channel blockers (diltiazem) - ACEI - enalapril - Low dose aspirin or clopidogrel (Plavix) *Medain survival time is approx. 732 days (recurrent heart failure, sudden death, arterial emboli)

Glycoprotein (GP) IIb/IIIa Inhibitors

- Inhibit platelet aggregation by preventing fibrin binding platelets - For UA/NSTEMI - STEMI only ReoPro - In combo w/ aspirin, heparin & Plavix before PCI - Not indicated if PCI not planned EX: Integrilin, ReoPro, Aggrastat

ACS (acute coronary syndrome)

- Mild, severe, or no chest pain or discomfort - nausea, vomiting - onset of sweating - pain that radiates to left arm - difficulty breathing - epigastric pain

*Respiratory Assessment: Pediatric Upper Airway* -__________ airway causes increased airway resistance -With ______/______ the airway has increased resistance

-*Narrow airway* causes increased airway resistance -With *edema/mucous* the airway has increased resistance

What 4 things in pediatric airway can increase risk of occlusion or obstruction?

-*Small nasopharynx* easily occluded -*Smaller nares* easily occluded -*Small oral cavity and large tongue* increase risk of obstruction -*Long floppy epiglottis* vulnerable to swelling causing obstruction

*Sonorous Wheeze (adventitious sounds)* -Coarse _______-pitched, sounds like a ________. -Air passing through thick secretions that partially obstruct the larger _______ and _______. -also called what???

-Coarse *low-pitched*, sounds like a *snore* -Air passing through thick secretions that partially obstruct the *larger bronchi and trachea* -also called *rhonchi??*

*Fine crackles (adventitious sounds)* -Heard at the end of ________. -Air passing through secretions in ________ and ________. -Upper or Lower airway? -EX: sounds similar to what sound?

-Heard at the end of *inspiration* -Air passing through secretions in *alveoli and bronchioles* -*Lower* airway -*Rub piece of hair together beside ear*

*Sibilant Wheeze (adventitious sounds)* -Musical ______ or ______ noise -During inspiration or expiration? -Bronchospasm or anatomic narrowing of the__________. -EX: Hear with _______.

-Musical *squeaking or hissing* noise -During *inspiration or expiration* EITHER -Bronchospasm or anatomic narrowing of the *bronchioles* -EX: Hear with *asthma*

What are 7 signs indicate difficulty breathing?

-Nasal flaring (enlargement of the nostrils helps reduce nasal resistance and maintain airway patency) -Head bobbing (head bobs forward with each breath) -Grunting -Color changes (mottling, pallor, gray, cyanosis) -Clubbing -Cough -Stridor (upper airway narrowing)

Observation of respiration's (5)

-Rate... Faster, increased metabolic rate and need for oxygen -Rhythm ...regular, irregular, periodic -Brief periods of apnea< 10-15 seconds (if baby is not breathing, try and stimulate them) -Depth -Respiratory Effort

SIDE NOTE: -Simple interventions for resp problem= reposition -Little kids love to put small things in their mouth. If have a small part can only go 2 places: Pocket or trash!

-Simple interventions for resp problem= reposition -Little kids love to put small things in their mouth. If have a small part can only go 2 places: Pocket or trash!

The nurse is teaching a patient about the safe administration of nitroglycerin (Nitrostat). Which patient statement indicates a correct understanding of the information presented?

1. "I should place the tablet under my tongue." (sublingual route to avoid first-pass effect and for rapid delivery)

Cr infant

.4 - 1.2

Creatinine

.7-1.4

ESR in children

0-35 po

PR segment

0.10 sec delay at AV node from end of p to beginning of complex (Q not always seen)

Bilirubin

0.3 - 1.0 mg/dL

Digoxin

0.5 - 2; Toxic > 2.5

Normal digoxin levels

0.5-2.0 ng/mL

Normal Creatinine

0.6-1.35 (<2 in elderly)

Quinidine

1 - 5 mcg/mL

A patient is to be discharged with a transdermal nitroglycerin patch. Which instruction will the nurse include in the patient's teaching plan?

1. "Apply the patch to a non hairy area of the upper torso or arm."

The nurse knows that simvastatin (Zocor) exerts its action by doing what?

1. By inhibiting the enzyme HMG-CoA reductase.

The nurse is caring for a patient who is prescribed diltiazem (Cardizem) for Prinzmetal's angina. Upon reviewing the patient's medical history, the nurse notes that the patient is also prescribed atenolol (Tenormin) for hypertension. What should the nurse assess prior to administering these medications?

1. Heart rate. (bradycardia can occur when a calcium channel blocker and a beta blocker are used together)

A patient who receives digoxin (Lanoxin) therapy states, "I missed one dose of the drug." The nurse learns that the patient hasn't taken the drug for the past 12 hours. What will the nurse do next?

1. Immediately inform the primary health care provider. (A physician must order tapering or continuation after a 12 hour lapse of digoxin)

The nurse is monitoring a patient receiving alteplase (Activase) for treatment of an arterial embolism in the left leg. Which finding indicates that the therapy is effective?

1. Left leg warm to touch. (When the clot is dissolved by the drug, circulation will return to the affected extremity)

A patient will be discharged to continue treatment with simvastatin (Zocor). The nurse will teach the patient to report which symptom?

1. Muscle pain. (It could indicate rhabdomyolysis, a serious adverse effect of statins)

What does the nurse administer when a patient has a sudden attack of angina?

1. Nitroglycerin (Nitro-Bid)

A patient who is receiving heparin therapy has bruises covering the abdomen as well as red-colored urine. What does the nurse need to assess?

1. Platelet level. (The patient may have heparin-induced thrombocytopenia (HIT) and the platelet levels must be assessed often)

A patient is receiving transdermal clonidine (Catapres). What information does the nurse need to include in the teaching plan?

1. Remove the old patch before applying the new patch.

The nurse is caring for a patient who is scheduled to receive a first dose of an alpha adrenergic agonist drug. The nurse is prepared to monitor the patient for which effect?

1. Syncopy. (First-dose syncope is associated with alpha adrenergic agonists)

Which condition is a contraindication to therapy with an anti platelet drug?

1. Vitamin K deficiency. (also known drug allergy to a specific product, thrombocytopenia, active bleeding, leukemia, traumatic injury, GI ulcer, and recent stroke)

Specific gravity

1.010 - 1.030

Therapeutic PT/PTT 1.5 - 2.0 times control

1.5 - 2.0 times control

Magnesium

1.5 - 2.5 mEq/L

Lidocaine

1.5 mcg/dL

Normal Mg

1.5-2.5

creatinine clearance

1.5-2.5

magnesium

1.5-2.5

he physician should adjust anticoagulant dosages as needed, to maintain PT at

1.5-2.5 time the control value

Bleeding Time

1.5-9.5

Prothrombin Time (PT)

10 - 12 seconds (control)

Dilantin

10 - 20 mcg/dL

Theophylline

10 - 20 mcg/dL

What method would you use to calculate HR for an irregular rhythm?

10 multiplied t he number of Rs in a 6 second strip

phenytoin

10 to 20

theophylline

10 to 20

Therapeutic Dilantin level

10-20

Therapeutic Theophylline level

10-20

what is the pacemaker potential rate for the SA node

100 bpm parasympathetic dominance slows it to 75-80 bpm

Normal LDH

100-190

triglycerides

100-200 mg/dL

What is the HR of Paroxysmal Supraventricular Tachy?

100-300

Rate of junctional tachycardia

101-140

Lilley Ch.26 pg. 434-435 7. The order for enoxaparin (Lovenox) reads: Give 1 mg/kg subcut every 12 hours. The patient weighs 242 lb, and the medication is available in an injection form of 120 mg/0.8 mL. How many milligrams will this patient receive? How many milliliters will the nurse draw up for the injection? (Round to hundredths.)

110 mg; 0.73 mL

Lilley Ch.26 pg. 434-435 8. The nurse is assessing a patient who has a new prescription for vorapaxr (zontivity). Which of these conditions are considered contraindications to use of vorapaxar? (Select all that apply.) a. Impaired renal function b. Impaired liver function c. History of myocardial infarction d. Peripheral artery disease e. History of stroke

110 mg; 0.73 mL

platelet

150000 - 400000

Normal Contraction frequency/duration/intensity

2-5 mins apart <90 seconds <100 mmHg

CVP Normal

2-6 measured in right atrium if it goes up too fast, fluid is pooling in R atrium

The patient taking methydopa (Aldomet) is found to have liver disease. What is the nurse's best action?

2. Notify the health care provider. (Never use Aldomet with patients with impaired liver function... they must now be tapered off)

The nurse is caring for several patient. Which patient will need teaching about treatment for hypertension?

2. The patient with a systolic pressure consistently above 140 mm Hg.

PT/INR

2.0 - 3.0

Phosphorus

2.5 - 4.5 mEq/L

27. Adults age ____ and older should have a fasting lipid profile performed at least once every 5 years.

20

Amikacin Peak:

20-30 mcg/mL Trough: <10 mcg/mL

what is the pacemaker potential rate for the Bundle of His/Purkinje Fibers

20-40 bpm

PTT

20-40 sec. normal 1.5-2.5x = therapeutic

Normal Plt

200,000-400,000

Normal CPK

21-232

NaHCO3

22 - 26

HCO3

22-26 mEq/L

HCo3

22-26 mEq/L

Respiratory disease account for approx. _____% of all pediatric hospitalizations

25%

P. 409 7. A patient is in the emergency department with new-onset rapid-rate atrial fibrillation. The nurse is about to add a continuous infusion of diltiazem (Cardiazem) at 5 mg/hr, but must first give a bolus of 0.25 mg/kg over 2 minutes. The patient weighs 220 pounds. The medication comes in a vial of 5 mg/mL. How many milligrams will the patient receive, and how many milliliters will the nurse draw up for this dose?

25mg, 5 mL

Mean Corpuscular Value (MCH)

27 - 31

EKG Paper: black marks at the top indicate how many seconds?

3 seconds between black marks

What is the elimination half-life of valsartan (Diovan)?

3. 6 hours. (Valsartan is an angiotensin II receptor blocker)

Which patient will the nurse expect to be given nitroglycerin (Nitrostat)?

3. A patient with coronary heart disease who complains of chest pain.

A patient with congestive heart failure (CHF) is prescribed hydralazine/isosorbide dintrate (BiDil). To minimize side effects what instruction will the nurse give the patient?

3. Change position carefully while taking the medication.

The nurse is caring for a patient who is scheduled to begin treatment with carvedilol (Coreg). While updating the history, the patient tells the nurse that he experiences frequent attacks of asthma. What is the nurse's highest priority action?

3. Notify the health care provider of this information. (A hx of asthma is considered to be a contraindication for use of carvedilol (Coreg)

The nurse is preparing to administer an anticoagulant to a patient. Which action, if observed, is in error?

3. The nurse administers enoxaparin (Lovenox) intramuscularly to a patient. (never give an IM injection of an anticoagulant, it can cause local bleeding in the muscle and a hematoma at the injection site)

The nurse is caring for several patients who are all being treated for hypertension. Which patient will the nurse assess first?

3. The patient who has stopped taking a betablocker due to cost. (abrupt cessation can cause rebound HTN)

A patient with nonvalvular atrial fibrillation is receiving dabigatran (Pradaxa) therapy. After assessing the patient, the nurse concludes that the patient is receiving effective treatment. Which finding supports the nurse's conclusion?

3. The patient's extremities are pink and warm. (The anticoagulant action of the drug prevents thrombus formation... there is no peripheral clotting as indicated by the assessment findings)

Evolve 1. The nurse is caring for a pediatric patient with a prescription for 0.2 mg/kg bolus of verapamil (Calan). What is the correct dose for a pediatric patient with a weight of 34 lb?

3.1 mg The pediatric patient's weight of 34 lb is converted to kilograms by dividing 34 by 2.2, which equals 15.45 kg. When 15.45 kg is multiplied by 0.2 mg/kg, the result is 3.09 mg, which rounds to 3.1 mg.

Albumin

3.4 - 5.0 g/dL

Normal Albumin

3.4-5.0

Uric Acid

3.5 - 7.5 mg/dL

Normal K

3.5-5.0

serum Albumin

3.5-5.5

Activated Partial Thromboplastin Time (aPTT)

30 - 45 seconds (control)

a respiratory rate that exceeds __ breaths/min is not problematic. Similarly, oxygen saturation slightly below __% does not necessitate cessation of activity.

30 96%

aPTT* according to MedScape

30-40

Vancomycin Peak:

30-40 mcg/mL Trough: 5-10mcg/mL

normal pulse pressure range

30-50

Hct

35-42

co2

35-45 mEq/L

PaCO2

35-45 mmHg

HDL cholesterol

35-85

how many cell membranes does and O2 molecule must cross to pass from plasma to tissue cells

3; two sides of the endothelial cell and one from the tissue cell

Carbamezapine

4 - 12 mcg/dL

Hemoglobin A1c (Hgb A1c)

4 - 6%

Procainamide

4 - 8 mcg/mL

When teaching a patient about the drug atenolol (Tenormin), what information will the nurse include in the teaching plan?

4. "Do not stop the medication abruptly." (Stopping any betablocker abruptly can lead to dangerous rebound HTN)

A nurse is monitoring a patient with angina for therapeutic effects of nitroglycerine (Nitrostat). Which assessment finding indicates that the nitroglycerine has been effective?

4. Patient stating that pain is 0 out of 10. (The therapeutic response of Nitro is absence of chest pain.)

pH of urine

4.5 - 8.0

Normal RBC

4.5-5 million

Urine ph

4.5-8 (average is 6)

RBC

4.7-6.1 (male) // 4.2-5.4 (female)

Mean Corpuscular Volume (MCV)

80 - 100

PaO2

80 - 100

What is the rate of Idioventricular rhythm

40 or less

Protein

6.2 - 8.1 g/dL

Normal Protein

6.2-8.1

GTT fasting

60 - 110

what is the pacemaker potential rate for the AV node

60 bpm

BUN

7-20

blood pH

7.35 - 7.45

pH

7.35-7.45

PaO2

80-100 mmHg

pao2

80-100 mmHg

Calcium

8.2 - 10.2 mg/L

Normal Ca

8.5-10.9

28. Individuals with a blood pressure greater than 120/____ are considered prehypertensive and at risk for heart disease.

80

suction pressure

80-120 mmHg

Creatnine Clearance

85-135

pt

9.5 to 12 sec

Cholesterol

<160

Normal International Ratio (INR)

<2

ESR

<25

ESR Child

<35

Normal PSA

<4

bradycardia

<60 bpm

O2 is lower with an altitude of

> 3kft

tachycardia

>100 bpm

GTT 1 hour

>190 mg/dL

*Respiratory Rates by pediatric life support* >1 day -1 year: >1 year-3 years: >3 years-5 years: >5 years-12 years: >12 years and older:

>1day -1 year: *30-60* >1 year-3 years: *24-40* >3 years-5 years: *22-34* >5 years-12 years: *18-30* >12 years and older: *12-18*

High-density Lipoprotein (HDL)

>45

In palpating the patient's pedal pulses, the nurse determines the pulses are absent. What factor could contribute to this result? a. Atherosclerosis b. Hyperthyroidism c. Arteriovenous fistula d. Cardiac dysrhythmias

A Atherosclerosis can cause an absent peripheral pulse. The feet would also be cool and may be discolored. Hyperthyroidism causes a bounding pulse. Arteriovenous fistula gives a thrill or vibration to the vessel, although this would not be in the foot. Cardiac dysrhythmias cause an irregular pulse rhythm.

The nurse is providing care for a patient who has decreased cardiac output related to heart failure. What should the nurse recognize about cardiac output? a. It is calculated by multiplying the patient's stroke volume by the heart rate. b. It is the average amount of blood ejected during one complete cardiac cycle. c. It is determined by measuring the electrical activity of the heart and the patient's heart rate. d. It is the patient's average resting heart rate multiplied by the patient's mean arterial blood pressure.

A Cardiac output is determined by multiplying the patient's stroke volume by heart rate, thus identifying how much blood is pumped by the heart over a 1-minute period. Electrical activity of the heart and blood pressure are not direct components of cardiac output.

An older adult patient with chronic heart failure (HF) and atrial fibrillation asks the nurse why warfarin has been prescribed to continue at home. What is the best response by the nurse? a. "The medication prevents blood clots from forming in your b. "The medication dissolves clots that develop in your coronary arteries." c. "The medication reduces clotting by decreasing serum potassium levels." d. "The medication increases your heart rate so that clots do not form in your heart."

A Chronic HF causes enlargement of the chambers of the heart and an altered electrical pathway, especially in the atria. When numerous sites in the atria fire spontaneously and rapidly, atrial fibrillation occurs. Atrial fibrillation promotes thrombus formation within the atria with an increased risk of stroke and requires treatment with cardioversion, antidysrhythmics, and/or anticoagulants. Warfarin is an anticoagulant that interferes with hepatic synthesis of vitamin K-dependent clotting factors.

A patient with a history of myocardial infarction is scheduled for a transesophageal echocardiogram to visualize a suspected clot in the left atrium. What information should the nurse include when teaching the patient about this diagnostic study? a. IV sedation may be administered to help the patient relax. b. Food and fluids are restricted for 2 hours before the procedure. c. Ambulation is restricted for up to 6 hours before the procedure. d. Contrast medium is injected into the esophagus to enhance images.

A IV sedation is administered to help the patient relax and ease the insertion of the tube into the esophagus. Food and fluids are restricted for at least 6 hours before the procedure. Smoking and exercise are restricted for 3 hours before exercise or stress testing but not before TEE. Contrast medium is administered IV to evaluate the direction of blood flow if a septal defect is suspected.

At a clinic visit, the nurse provides dietary teaching for a patient recently hospitalized with an exacerbation of chronic heart failure. The nurse determines that teaching is successful if the patient makes which statement? a. "I will limit the amount of milk and cheese in my diet." b. "I can add salt when cooking foods but not at the table." c. "I will take an extra diuretic pill when I eat a lot of salt." d. "I can have unlimited amounts of foods labeled as reduced sodium."

A Milk products should be limited to 2 cups per day for a 2500-mg sodium-restricted diet. Salt should not be added during food preparation or at the table. Diuretics should be taken as prescribed (usually daily) and not based on sodium intake. Foods labeled as reduced sodium contain at least 25% less sodium than regular.

The patient with chronic heart failure is being discharged from the hospital. What information should the nurse emphasize in the patient's discharge teaching to prevent progression of the disease to acute decompensated heart failure (ADHF)? a. Take medications as prescribed. b. Use oxygen when feeling short of breath. c. Only ask the physician's office questions. d. Encourage most activity in the morning when rested.

A The goal for the patient with chronic HF is to avoid exacerbations and hospitalization. Taking the medications as prescribed along with nondrug therapies such as alternating activity with rest will help the patient meet this goal. If the patient needs to use oxygen at home, it will probably be used all the time or with activity to prevent respiratory acidosis. Many HF patients are monitored by a care manager or in a transitional program to assess the patient for medication effectiveness and monitor for patient deterioration and encourage the patient. This nurse manager can be asked questions or can contact the health care provider if there is evidence of worsening HF.

Lead II

A bipolar lead in which the positive electrode is placed over the apex of the heart (in the left midclavicular line at the 4th or 5th intercostal space). The negative electrode is placed beneath the clavicle to the right of the sternum near the 2nd intercostal space

Bruit vs murmur

A heart murmur is an extra or unusual HS heard during a heartbeat. Murmurs range from very faint to very loud. Sometimes they sound like a whooshing or swishing noise >> could be due to regurgitation, or blood going back into the wrong valve. Bruit , or "vascular murmur", is the abnormal sound generated by turbulent flow of blood in an artery due to either an area of partial obstruction; or a localized high rate of blood flow through an unobstructed artery. The bruit may be heard ("auscultated") by pressing a stethoscope to the skin over the turbulent flow and listening.

Glucagon

A hormone secreted by the pancreatic alpha cells that increases blood glucose concentration

Angiotensin

A normal blood protein produced by the liver, angiotensin is converted to angiotensim I by renin (secreted by kidney when blood pressur falls). Angiotensin I si further onverted to angiotensim II by ACE (angiotensin converting enzyme). Angiotensin II is a powerful systemic vasocontrictor ans stimulator of aldosterone relase, both of which result in an increase in blood pressure.

acute coronary syndrome

A term used to describe a group of symptoms caused by myocardial ischemia; includes angina and myocardial infarction.

Which blood vessel carries oxygenated blood toward the heart from the lungs? A. Pulmonary vein B. Pulmonary artery C. Inferior vena cava D. Superior vena cava

A. The pulmonary vein, in contrast to all other veins, carries oxygenated blood toward the heart from the lungs. The pulmonary artery carries deoxygenated blood from the right ventricle to the lungs. The inferior vena cava carries deoxygenated blood from the legs and abdomen to the right atrium of the heart. The superior vena cava carries deoxygenated blood from the arms and head to the right atrium of the heart. Text Reference - p. 689

A nurse is caring for a client who is receiving hemodynamic monitoring readings: PAS 34 mm Hg, PAD 21 mm Hg, PAWP 16 mm Hg, CVP 12 mm Hg. For which of the following is the client at risk? (Select all that apply) A. Heart Failure B. Cor pulmonale C. Hypovolemic shock D. Pulmonary hypertension E. Peripheral edema

A, B, D, E A. Heart failure is associated with left ventricular failure and would be indicated by elevated hemodynamic readings B. Cor pulmonale is associated with the right side of the heart, and pulmonary problems would be indicated by elevated hemodynamic readings D. Pulmonary hypertension is associated with high blood pressure in the pulmonary arteries, affects the right side of the heart, and would be indicated by elevated hemodynamic readings E. Peripheral edema is associated with left ventricular failure and would be indicated by elevated hemodynamic readings

A patient admitted with heart failure is anxious and reports shortness of breath. Which nursing actions would be appropriate to alleviate this patient's anxiety (select all that apply.)? a. Administer ordered morphine sulfate. b. Position patient in a semi-Fowler's position. c. Position patient on left side with head of bed flat. d. Instruct patient on the use of relaxation techniques. e. Use a calm, reassuring approach while talking to patient.

A, B, D, E Morphine sulfate reduces anxiety and may assist in reducing dyspnea. The patient should be positioned in semi-Fowler's position to improve ventilation that will reduce anxiety. Relaxation techniques and a calm reassuring approach will also serve to reduce anxiety.

The nurse is caring for an older adult patient. What age-related cardiovascular changes should the nurse assess for when providing care for this patient (select all that apply.)? a. Systolic murmur b. Diminished pedal pulses c. Increased maximal heart rate d. Decreased maximal heart rate e. Increased recovery time from activity

A, B, D, E Well-documented cardiovascular effects of the aging process include valvular rigidity leading to systolic murmur, arterial stiffening leading to diminished pedal pulses or possible increased blood pressure, and an increased amount of time that is required for recovery from activity. Maximal heart rate tends to decrease rather than increase with age related to cellular aging and fibrosis of the conduction system.

A nurse is reviewing a new prescription to administer 0.9% NaCl IV at 50 ml/hr to a client who is receiving hemodynamic monitoring and has an indwelling IV catheter in the left hand. Which of the following sites can be used for administering this solution? (Select all that apply) A. Peripheral saline lock B. Port on the arterial line C. Port on proximal (CVP) lumen of pulmonary artery (PA) catheter D. Port on distal lumen of PA catheter E. Balloon inflation port

A, C A. IV fluid administration can occur via a lock on a peripheral IV catheter C. The proximal (CVP) lumen of a PA catheter is used for hemodynamic monitoring and can also be used for IV fluid administration.

The patient had myocarditis and is now experiencing fatigue, weakness, palpitations, and dyspnea at rest. The nurse assesses pulmonary crackles, edema, and weak peripheral pulses. Sinoatrial tachycardia is evident on the cardiac monitor. The Doppler echocardiography shows dilated cardiomyopathy. What collaborative and nursing care of this patient should be done to improve cardiac output and the quality of life (select all that apply.)? a. Decrease preload and afterload. b. Relieve left ventricular outflow obstruction. c. Control heart failure by enhancing myocardial d. Improve diastolic filling and the underlying disease process. e. Improve ventricular filling by reducing ventricular contractility.

A, C The patient is experiencing dilated cardiomyopathy. To improve cardiac output and quality of life, drug, nutrition, and cardiac rehabilitation will be focused on controlling heart failure by decreasing preload and afterload and improving cardiac output, which will improve the quality of life. Relief of left ventricular outflow obstruction and improving ventricular filling by reducing ventricular contractility is done for hypertrophic cardiomyopathy. There are no specific treatments for restrictive cardiomyopathy, but interventions are aimed at improving diastolic filling and the underlying disease process.

A nurse is caring for a patient immediately following a transesophageal echocardiogram (TEE). Which assessments are appropriate for this patient (select all that apply.)? a. Assess for return of gag reflex. b. Assess groin for hematoma or bleeding. c. Monitor vital signs and oxygen saturation. d. Position patient supine with head of bed flat. e. Assess lower extremities for circulatory compromise.

A, C The patient undergoing a TEE has been given conscious sedation and has had the throat numbed with a local anesthetic spray, thus eliminating the gag reflex until the effects wear off. Therefore it is imperative that the nurse assess for gag reflex return before allowing the patient to eat or drink. Vital signs and oxygen saturation are also important assessment parameters resulting from the use of sedation. A TEE does not involve invasive procedures of the circulatory blood vessels. Therefore it is not necessary to monitor the patient's groin and lower extremities in relation to this procedure or to maintain a flat position.

The patient has heart failure (HF) with an ejection fraction of less than 40%. What core measures should the nurse expect to include in the plan of care for this patient (select all that apply.)? a. Left ventricular function is documented. b. Controlling dysrhythmias will eliminate HF. c. Prescription for digoxin (Lanoxin) at discharge d. Prescription for angiotensin-converting enzyme inhibitor at discharge e. Education materials about activity, medications, weight monitoring, and what to do if symptoms worsen

A, D, E The Joint Commission has identified these three core measures for heart failure patients. Although controlling dysrhythmias will improve CO and workload, it will not eliminate HF. Prescribing digoxin for all HF patients is no longer done because there are newer effective drugs and digoxin toxicity occurs easily related to electrolyte levels and the therapeutic range must be maintained.

Which effects of aging on the cardiovascular system should the nurse anticipate when providing care for older adults (select all that apply)? A. Systolic murmur B. Diminished pedal pulses C. Increased maximal heart rate D. Decreased maximal heart rate E. Increased recovery time from activity

A,B,D,E. Well-documented cardiovascular effects of the aging process include valvular rigidity leading to systolic murmur, arterial stiffening leading to diminished pedal pulses or possible increased blood pressure, and an increased amount of time that is required for recovery from activity. Maximal heart rate tends to decrease rather than increase with age related to cellular aging and fibrosis of the conduction system.

A nurse is caring for a patient immediately following a transesophageal echocardiogram (TEE). Which assessments are appropriate for this patient (select all that apply)? A. Assess for return of gag reflex. B. Assess groin for hematoma or bleeding. C. Monitor vital signs and oxygen saturation. D. Position patient supine with head of bed flat. E. Assess lower extremities for circulatory compromise.

A,C. The patient undergoing a TEE has been given conscious sedation and has had the throat numbed with a local anesthetic spray, thus eliminating the gag reflex until the effects wear off. Therefore it is imperative that the nurse assess for gag reflex return before allowing the patient to eat or drink. Vital signs and oxygen saturation are also important assessment parameters resulting from the use of sedation. A TEE does not involve invasive procedures of the circulatory blood vessels. Therefore it is not necessary to monitor the patient's groin and lower extremities in relation to this procedure or to maintain a flat position.

While conducting a cardiac assessment for a patient who is 78 years old, the nurse notes that he is suffering from sinus dysrhythmias. A reduction in which type of cells leads to this condition? A. Pacemaker cells in the sinoatrial (SA) node B. Conduction cells in the internodal tracts C. Conduction cells in the bundle of His D. Conduction cells in the bundle branches

A. A reduction in the number of pacemaker cells in the SA node may account for sinus dysrhythmias in the older adult patient. Reductions in the number of conduction cells in the internodal tracts, bundle of His, and bundle branches contribute to the development of atrial dysrhythmias and heart blocks. STUDY TIP: Focus your study time on the common health problems that nurses most frequently encounter. Text Reference - p. 691

In palpating the patient's pedal pulses, the nurse determines the pulses are absent. What factor could contribute to this result? A. Atherosclerosis B. Hyperthyroidism C. Arteriovenous fistula D. Cardiac dysrhythmias

A. Atherosclerosis can cause an absent peripheral pulse. The feet would also be cool and may be discolored. Hyperthyroidism causes a bounding pulse. Arteriovenous fistula gives a thrill or vibration to the vessel, although this would not be in the foot. Cardiac dysrhythmias cause an irregular pulse rhythm.

The nurse is providing care for a patient who has decreased cardiac output related to heart failure. What should the nurse recognize about cardiac output? A. Calculated by multiplying the patient's stroke volume by the heart rate B. The average amount of blood ejected during one complete cardiac cycle C. Determined by measuring the electrical activity of the heart and the patient's heart rate D. The patient's average resting heart rate multiplied by the patient's mean arterial blood pressure

A. Cardiac output is determined by multiplying the patient's stroke volume by heart rate, thus identifying how much blood is pumped by the heart over a 1-minute period. Electrical activity of the heart and blood pressure are not direct components of cardiac output.

A 64-year-old patient with a history of myocardial infarction is scheduled for a transesophageal echocardiogram to visualize a suspected clot in the left atrium. What information should the nurse include when teaching the patient about this diagnostic study? A. IV sedation may be administered to help the patient relax. B. Food and fluids are restricted for 2 hours before the procedure. C. Ambulation is restricted for up to 6 hours before the procedure. D. Contrast medium is injected into the esophagus to enhance images.

A. IV sedation is administered to help the patient relax and ease the insertion of the tube into the esophagus. Food and fluids are restricted for at least 6 hours before the procedure. Smoking and exercise are restricted for 3 hours before exercise or stress testing, but not before TEE. Contrast medium is administered IV to evaluate the direction of blood flow if a septal defect is suspected.

A patient with a myocardial infarction is preparing for discharge, following successful treatment. What is important for the nurse to include in the discharge teaching related to elimination? A. "Avoid straining during bowel movement." B. "Avoid passing stools after having food." C. "Avoid passing stools more than once a day." D. "Take medicine for constipation."

A. It is extremely important that the patient doesn't strain during bowel movement. Straining during bowel movement puts pressure on the heart for circulation of blood. This can aggravate heart troubles. Passing stools after food and passing stools more than once a day are absolutely fine and do not affect the patient. Advising the patient to take unsupervised over-the-counter (OTC) drugs is not advisable, because they can be detrimental to the patient's health. Text Reference - p. 693

During a physical examination of a patient, the nurse performs a capillary refill test. What test finding should the nurse consider as normal? A. Capillary refill time of two seconds B. Capillary refill time of four seconds C. Capillary refill time of six seconds D. Capillary refill time of eight seconds

A. The capillary refill test assesses the perfusion function of the body. The fingernail is pressed and the time required for refilling of blood is noted. This refill is appreciated by the change in color of the nail bed. Under normal circumstances, the capillary refill time is two seconds or less. More than two seconds indicates inadequate perfusion. Capillary refill times of four seconds, six seconds, and eight seconds indicate an underlying defect in circulation. Text Reference - p. 695

How does the endothelium respond if a rupture occurs on the endothelial surface of an artery? A. Initiates coagulation cascade B. Promotes blood flow in the artery C. Decreases viscosity of the blood in the artery D. Decreases platelet aggregation at the ruptured site

A. The endothelium is the innermost layer of the arteries in the body. After damage to any part of the artery, it initiates cascade formation and aids in the formation of a fibrin clot to reduce the risk of bleeding. The endothelium promotes blood flow in the artery during normal conditions, but not after a rupture. The endothelium does not decrease the viscosity of the blood in the artery in either normal or damaged conditions. The endothelium increases platelet aggregation at the ruptured site to repair the ruptured part of the epithelial surface. Text Reference - p. 689

A nurse is caring for a client who has heart failure and asks how to limit fluid intake to 2,000 mL/day. Which of the following is an appropriate response by the nurse? A. "Pour the amount of fluid you drink into an empty 2 liter bottle to keep track of how much you drink." B. "Each glass contains 8 ounces. There are 30 milliliters per ounce, so you can have a total of 8 glasses or cups of fluid each day." C. "This is the same as 2 quarts, or about the same as two pots of coffee." D. "Take sips of water or ice chips so you will not take in too much fluid."

A. "Pour the amount of fluid you drink into an empty 2 liter bottle to keep track of how much you drink."

The term automaticity refers to the ability of the cell to: A. Initiate an impulse on it's own B. Send impulses in all directions C. Block impulses formed in areas other than the SA node

A. Automaticity, the ability of the cell to initiate an impulse on its own, is a unique characteristic of cardiac cells

A nurse is teaching a client who has heart failure about the need to limit sodium in the diet to 2,000 mg daily. Which of the following foods should be consumed in limited quantities? (Select all that apply.) A. Cheddar cheese, 2 oz B. Hot dog C. Canned tuna, 3 oz D. Roast chicken breast, 3 oz E. Baked ham, 3 oz

A. Cheddar cheese, 2 oz B. Hot dog C. Canned tuna, 3 oz E. Baked ham, 3 oz

The patient had myocarditis and is now experiencing fatigue, weakness, palpitations, and dyspnea at rest. The nurse assesses pulmonary crackles, edema, and weak peripheral pulses. Sinoatrial tachycardia is evident on the cardiac monitor. The Doppler echocardiography shows dilated cardiomyopathy. What collaborative and nursing care of this patient should be done to improve cardiac output and the quality of life? (Select all that apply.) A. Decrease preload and afterload. B. Relieve left ventricular outflow obstruction. C. Control heart failure by enhancing myocardial contractility. D. Improve diastolic filling and the underlying disease process. E. Improve ventricular filling by reducing ventricular contractility.

A. Decrease preload and afterload. C. Control heart failure by enhancing myocardial contractility. The patient is experiencing dilated cardiomyopathy. To improve cardiac output and quality of life, drug, nutrition, and cardiac rehabilitation will be focused on controlling heart failure by decreasing preload and afterload and improving cardiac output, which will improve the quality of life. Relief of left ventricular outflow obstruction and improving ventricular filling by reducing ventricular contractility is done for hypertrophic cardiomyopathy. There are no specific treatments for restrictive cardiomyopathy, but interventions are aimed at improving diastolic filling and the underlying disease process.

While doing an admission assessment, the nurse notes clubbing of the patient's fingers. Based on this finding, the nurse will question the patient about which disease process? A. Endocarditis B. Acute kidney injury C. Myocardial infarction D. Chronic thrombophlebitis

A. Endocarditis Clubbing of the fingers is a loss of the normal angle between the base of the nail and the skin. This finding can be found in endocarditis, congenital defects, and/or prolonged oxygen deficiency. Clinical manifestations of acute kidney injury, myocardial infarction, and chronic thrombophlebitis will not include clubbing of the fingers.

When caring for a patient with infective endocarditis, the nurse will assess the patient for which vascular manifestations (select all that apply)? A. Osler's nodes B. Janeway's lesions C. Splinter hemorrhages D. Subcutaneous nodules E. Erythema marginatum lesions

A. Osler's nodes B. Janeway's lesions C. Splinter hemorrhages Osler's nodes, Janeway's lesions, and splinter hemorrhages are all vascular manifestations of infective endocarditis. Subcutaneous nodules and erythema marginatum lesions occur with rheumatic fever.

The nurse is teaching a community group about preventing rheumatic fever. What information should the nurse include? A. Prompt recognition and treatment of streptococcal pharyngitis B. Completion of 4 to 6 days of antibiotic therapy for infective endocarditis of respiratory infections in children born with heart defects C. Avoidance of respiratory infections in children who have rheumatoid arthritis D. Requesting antibiotics before dental surgery for individuals with rheumatoid arthritis

A. Prompt recognition and treatment of streptococcal pharyngitis The nurse should emphasize the need for prompt and adequate treatment of streptococcal pharyngitis infection, which can lead to the complication of rheumatic fever.

While admitting a patient with pericarditis, the nurse will assess for what manifestations of this disorder? A. Pulsus paradoxus B. Prolonged PR intervals C. Widened pulse pressure D. Clubbing of the fingers

A. Pulsus paradoxus Pericarditis can lead to cardiac tamponade, an emergency situation. Pulsus paradoxus greater than 10 mm Hg is a sign of cardiac tamponade that should be assessed at least every 4 hours in a patient with pericarditis. Prolonged PR intervals occur with first-degree AV block. Widened pulse pressure occurs with valvular heart disease. Clubbing of fingers may occur in subacute forms of infective endocarditis and valvular heart disease.

Drug overview

ACE inhibitors- pril (Angiotensin coverters) Beta Blokers- olol (decrease workload of heart) Anti infectives: mycin Benzo's- pam Phenothiazine: zine (mental and emotional) Glucocorticoids: one Antivirals: vir Cholesterol: statin ARBs sartan (block angiotensin 2) H2: dine (treat duodenal and gastric ulcers) Proton pump inhibitors: zole (acid lowering) Anticoagulant: parin (prevent clots)

s/s indicating an active process of atherosclerotic plaque buildup, thrombus formation, or spasm within a coronary artery, causing a reduction or loss of blood flow to myocardial tissue; includes unstable angina and other pathological events leading to MI. early dx and rapid tx is critical to avoid or minimize damage to heart muscle

ACS

some pts. experience bradycardia

ACS

Balancing myocardial oxygen supply with demand

ACS Goal

O2 should be administered w/ med therapy to assist w/ s/s relief. o2 raises the circulating level of oxygen reducing low levels of myocardial oxygen/ pain. Physical rest in bed w/ the HOB elevated or in supportive chair helps decrease chest discomfort and dyspnea.

ACS NI

Peritonsillar abscess (PTA)

AKA quinsy Complication of acute tonsillitis Manifestations: Pus causing one sided swelling with deviation of the uvula Trismus ( tonic contraction of the muscles of mastication) difficulty breathing Bad breath, swollen lymph nodes

Angiotensin converting agents

Benazepril (Lotensin) Lisinopril (zestril) catopril (capoten) enalapril (vasotec) fosinopril (monopril) moexipril (univas) quinapril (acupril) ramipril (altace)

Cardiac Glycosides Adverse

Confusion Visual Disturbance Anorexia AV Block Dysrythmias

Contraindications of Cardiac Glycosides

AV Block Ventricular Dysrythmias

AV Node - __________ pacemaker with an intrinsic rate of ___ - ___ beats/minute

AV Node - *Back-up pacemaker* with an intrinsic rate of *40 - 60* beats/minute

what makes the lub sound

AV valves closing (atria filling)

Metabolic Acidosis= Metabolic Alkalosis=

Acidosis= Hyperkalemia Alkalosis= HypOkalemia

Antivirals

Acyclovir ritonavir saquinavir indinavir abacavir cidofavir ganciclovir

Too little Aldosterone

Addison's

Hypoaldosteronism

Addisons disease Lack of aldosterone to reabsorb Na+ and in turn water

CAD non-modifiable risk factors

Age Gender Ethnicity Family hx

If your patient does from squeaking sound to a wheezing sound, what does that indicate?

Air is going through very tight airway= squeaking>>tight is bad, because if close to tight wont get air through (hear nothing)> *going from squeaking to wheezing is a good thing because that mean airway is opening up*

K+ sparing diuretic

Aldactone

stimulates Na+ and water reabsorption

Aldosterone

stimulates the secretion of K+ into tubular lumen. Aldosterone stimulates Na+ and water reabsorption from the gut, salivary and sweat glands in exchange for K+.

Aldosterone

___ stimulates Na+ and water reabsorption from the ___

Aldosterone; gut

Iggy Ch.32 p. 610, Patient-Centered Care; Safety; Evidence-Based Practice The patient is a 70-year-old retiree who had a hip replacement 2 days ago. His hip pain kept him from participating in his usual exercise program for the past 6 months. He is a former two-pack a day smoker. At home he decreased his fluid intake because ambulating to the bathroom was so painful. He resisted getting out of bed with physical therapy yesterday. When you assess him this morning, he reports nausea, some chest pain, mild shortness of breath, and anxiety. 2. Which of his manifestations are associated with pulmonary embolism (PE), and what risk factors does he have for a PE?

All of his manifestations are associated with PE, even the vague ones. His risk factors include having had a hip replacement, continued inactivity, and possible dehydration.

Premature atrial contractions (PAC)

Also known as atrial premature complexes (APC) or atrial premature beats (APB), *are a common cardiac dysrhythmia characterized by premature heartbeats originating in the atria*

Alterations in the ________ and _________ systems may also threaten respiratory function.

Alterations in the *immune and neurologic systems* may also threaten respiratory function.

p. 614, Patient-Centered Care; Teamwork and Collaboration A 50-year old patient is admitted to the medical-surgical floor from the emergency department with severe abdominal pain thought to be from acute pancreatitis. He has a history of drinking at least a case of beer a day. He also smokes and appears cachectic. His old chart indicates a history of COPD, but he does not take medications for this. He does have a new productive cough. At change of shift, the nurse finds the patient dyspneic and slightly confused. Lung sounds have wheezes, and he is mildly febrile. Pulse is 120 beats/min, respirations are 32 breaths/min, and blood pressure is 118/64 mm Hg (baseline). Oximetry shows an SPO2 of 91%. 2. Explain the relationship between the lung sounds and the oximetry reading.

Although he has some wheezing, this is more likely related to his COPD and not to ARDS because the edema from ARDS occurs first in the interstitial spaces and not in the airways. The oximetry reading does indicate a gas exchange problem that is greater than expected from COPD alone.

Textbook Case Studies 4. The nurse reviews the prescriptions with A.F. and notes that there is a prescription for warfarin. A.F. states, "This dose is lower than what I was taking. Why is that?" What will the nurse explain to A.F. about the warfarin?

Amiodarone has a significant drug interaction with warfarin. It is reported that the INR will increase by 50% in almost 100% of patients taking warfarin in combination with amiodarone. Because of this potential increase in INR, A.F.'s warfarin dose will be lower at this time. The INR must be closely monitored, and necessary adjustments made to the warfarin dosage.

p. 616, Safe and Effective Care Environment The nurse caring for a client who is intubated and receiving mechanical ventilation notes that her oxygen saturation is 89%, her heart rate is 120 beats/min, and she is increasingly agitated and restless. On auscultation, the nurse finds the lung sounds are diminished on one side. Which action does the nurse perform first? A. Notify the provider and prepare for re-intubation or repositioning the tube. B. Document the findings and request sedation from the provider. C. Call respiratory therapy to obtain a set of arterial blood gasses. D. Reposition the tube, and call radiology for a stat chest x-ray.

Answer: A Rationale: With the decreased oxygen saturation and decreased breath sounds on one side, the endotracheal tube is incorrectly positioned into one bronchus. For effective gas exchange, the tube must be repositioned, which is a health care provider function, not a nursing function.

Iggy Ch.32 p. 608, Safe and Effective Care Environment While assessing a client who has been receiving heparin intravenously for the past 3 days, the nurse notes the IV pump is set at twice the required setting. What orders does the nurse anticipate from the prescriber? Select all that apply. A. Activated partial thromboplastin time B. International normalized ratio C. Prothrombin time D. Vitamin K E. Protamine sulfate

Answer: A, E Rationale: The client has been receiving an excessive dose of heparin. The activated partial thromboplastin time will help assess this client's degree of bleeding risk. Depending on the results of this test, the client may need a heparin antidote, which is protamine sulfate.

p. 619, Safe and Effective Care Environment A student nurse is working with a client in the ICU who is intubated and being mechanically ventilated. What action by the student causes the registered nurse to intervene? A. Repositioning the client every 2 hours B. Providing oral care with chlorhexidine rinse C. Checking tube placement at the client's incisor D. Turning off ventilator alarms while working in the room

Answer: D Rationale: Ventilator alarms are critical to safety and indicating a need for early intervention when the client's gas exchange needs are not being met. Even when a nurse or other health care professional is present at the bedside, the alarms should never be turned off or set so inappropriately that they do not sound when parameters indicate a problem.

Fondaparinux

Anticoagulant

Heparin

Anticoagulant

Warfarin

Anticoagulant

PCI tx

Anticoagulants prophylactically

Calcium Gluconate

Antidote for Mg toxicity administered IVPnvery slowly (max rate 1.5-2mL/min)

Vitamin K

Antidote to Warfarin

What occurs during asystole?

During asystole, the atria relax and fill with blood. The mitral and tricuspid valves are closed. Ventricular pressure rises and forces open the aortic and pulmonic valves

Aspirin

Antiplatlet

Dipyramide

Antiplatlet

Clopidogrel

Antiplatlet(ADP reseptor blocker)

Prasugrel

Antiplatlet(ADP reseptor blocker)

Ticagrelor

Antiplatlet(ADP reseptor blocker)

Ticlopidine

Antiplatlet(ADP reseptor blocker)

Abciximab

Antiplatlet(Glycoprotein IIb/IIIA receptor blocker

Eptifibatide

Antiplatlet(Glycoprotein IIb/IIIA receptor blocker

Tirofiban

Antiplatlet(Glycoprotein IIb/IIIA receptor blocker

common symptoms of MI among patients of all ages and genders.

Anxiety CP SOB

APGAR

Appearance Pulses Grimace Activity Reflexes --> Done at 1 & 5 minutes with a score of 0=absent, 1=decreased, 2=strongly positive

minimally invasive endovascular sx for removing atherosclerosis from bv within the body. It is an alternative to angioplasty for the treatment of peripheral artery disease, but the studies that exist are not adequate to determine if it is superior to angioplasty

Atherectomy

Cholesterol lowering drugs

Atorvastatin (lipitor) fluvastatin lovastatin pravastatin simvastatin (zocar)

veins lead to what part of the heart

Atria

Atrial flutter

Atrial flutter is a common tachycardia that results from a rapid electrical circuit in the atrium

PR Interval

Atrial impulse from atria through the AV node, bundle of HIS and right and left bundle branches. Normal PR: *From the beginning of the P wave to the beginning of the QRS complex* *.12-.20 seconds*

Antidote for Cholinergics

Atropine Sulfate

The nurse is performing an assessment for a patient undergoing radiation treatment for breast cancer. What position should the nurse place the patient to best auscultate for signs of acute pericarditis? a. Supine without a pillow b. Sitting and leaning forward c. Left lateral side-lying position d. Head of bed at a 45-degree angle

B A pericardial friction rub indicates pericarditis. To auscultate a pericardial friction rub, the patient should be sitting and leaning forward. The nurse will hear the pericardial friction rub at the end of expiration.

The home care nurse visits a patient with chronic heart failure. Which clinical manifestations, assessed by the nurse, would indicate acute decompensated heart failure (pulmonary edema)? a. Fatigue, orthopnea, and dependent edema b. Severe dyspnea and blood-streaked, frothy sputum c. Temperature is 100.4oF and pulse is 102 beats/min d. Respirations 26 breaths/min despite oxygen by nasal cannula

B Clinical manifestations of pulmonary edema include anxiety, pallor, cyanosis, clammy and cold skin, severe dyspnea, use of accessory muscles of respiration, a respiratory rate greater than 30 breaths/min, orthopnea, wheezing, and coughing with the production of frothy, blood-tinged sputum. Auscultation of the lungs may reveal crackles, wheezes, and rhonchi throughout the lungs. The heart rate is rapid, and blood pressure may be elevated or decreased.

A patient with a recent diagnosis of heart failure has been prescribed furosemide. What outcome does the nurse anticipate will occur that demonstrates medication effectiveness? a. Promote vasodilation. b. Reduction of preload. c. Decrease in afterload. d. Increase in contractility.

B Diuretics such as furosemide are used in the treatment of heart failure to mobilize edematous fluid, reduce pulmonary venous pressure, and reduce preload. They do not directly influence afterload, contractility, or vessel tone.

What should the nurse recognize as an indication for the use of dopamine in the care of a patient with heart failure? a. Acute anxiety b. Hypotension and tachycardia c. Peripheral edema and weight gain d. Paroxysmal nocturnal dyspnea (PND)

B Dopamine is a β-adrenergic agonist whose inotropic action is used for treatment of severe heart failure accompanied by hemodynamic instability. Such a state may be indicated by tachycardia accompanied by hypotension. PND, anxiety, edema, and weight gain are common signs and symptoms of heart failure, but these do not necessarily warrant the use of dopamine.

The nurse provides discharge instructions for a 40-yr-old woman newly diagnosed with cardiomyopathy. Which statement indicates that further teaching is necessary? a. "I will avoid lifting heavy objects." b. "I can drink alcohol in moderation." c. "My family will need to take a CPR course." d. "I will reduce stress by learning guided imagery."

B Patients with cardiomyopathy should avoid alcohol consumption, especially in patients with alcohol-related dilated cardiomyopathy. Avoiding heavy lifting and stress, as well as family members learning CPR, are recommended teaching points.

The patient informs the nurse that he does not understand how there can be a blockage in the left anterior descending artery (LAD), but there is damage to the right ventricle. What is the best response by the nurse? a. "The one vessel curves around from the left side to the right b. b. "The LAD supplies blood to the left side of the heart and part of c. "The right ventricle is supplied during systole primarily by the right coronary artery." d. "It is actually on your right side of the heart, but we call it the left anterior descending vessel."

B The best response is explaining that the lower portion of the right ventricle receives blood flow from the left anterior descending artery as well as the right coronary artery during diastole.

The nurse is preparing to administer digoxin to a patient with heart failure. In preparation, laboratory results are reviewed with the following findings: sodium 139 mEq/L, potassium 5.6 mEq/L, chloride 103 mEq/L, and glucose 106 mg/dL. What is the priority action by the nurse? a. Withhold the daily dose until the following day. b. Withhold the dose and report the potassium level. c. Give the digoxin with a salty snack, such as crackers. d. Give the digoxin with extra fluids to dilute the sodium level.

B The normal potassium level is 3.5 to 5.0 mEq/L. The patient is hyperkalemic, which makes the patient more prone to digoxin toxicity. For this reason, the nurse should withhold the dose and wait for the potassium level to normalize. The physician may order the digoxin to be given once the potassium level has been treated and decreases to within normal range.

The nurse is admitting a patient who is scheduled to undergo a cardiac catheterization. What allergy information is most important for the nurse to assess and document before this procedure? a. Iron b. Iodine c. Aspirin d. Penicillin

B The physician will usually use an iodine-based contrast to perform this procedure. Therefore it is imperative to know whether or not the patient is allergic to iodine or shellfish. Knowledge of allergies to iron, aspirin, or penicillin will be secondary.

While auscultating the patient's heart sounds with the bell of the stethoscope, the nurse hears these sounds. How should the nurse document what is heard? a. Diastolic murmur b. Third heart sound (S3) c. Fourth heart sound (S4) d. Normal heart sounds (S1, S2)

B The third heart sound is heard closely after the S2 and is known as a ventricular gallop because it is a vibration of the ventricular walls associated with decreased compliance of the ventricles during filling. It occurs with left ventricular failure. Murmurs sound like turbulence between normal heart sounds and are caused by abnormal blood flow through diseased valves. The S4 heart sound is a vibration caused by atrial contraction, precedes the S1, and is known as an atrial gallop. The normal S1 and S2 are heard when the valves close normally.

A patient with aortic valve stenosis is being admitted for valve replacement surgery. Which assessment finding documented by the nurse is indicative of this condition? a. Pulse deficit b. Systolic murmur c. Distended neck veins d. Splinter hemorrhages

B The turbulent blood flow across a diseased valve results in a murmur. Aortic stenosis produces a systolic murmur. A pulse deficit indicates a cardiac dysrhythmia, most commonly atrial fibrillation. Distended neck veins may be caused by right-sided heart failure. Splinter hemorrhages occur in patients with infective endocarditis.

The nurse is preparing to administer a nitroglycerin patch to a patient. When providing instructions regarding the use of the patch, what should the nurse include in the teaching? a. Avoid high-potassium foods b. Avoid drugs to treat erectile dysfunction c. Avoid over-the-counter H2-receptor blockers d. Avoid nonsteroidal antiinflammatory drugs (NSAIDS)

B The use of erectile drugs concurrent with nitrates creates a risk of severe hypotension and possibly death. High-potassium foods, NSAIDs, and H2-receptor blockers do not pose a risk in combination with nitrates.

A patient presents to the emergency department with reports of chest pain for 3 hours. What component of his blood work is most clearly indicative of a myocardial infarction (MI)? a. CK-MB b. Troponin c. Myoglobin d. C-reactive protein

B Troponin is the biomarker of choice in the diagnosis of MI, with sensitivity and specificity that exceed those of CK-MB and myoglobin. CRP levels are not used to diagnose acute MI.

The nurse is performing an assessment for a patient with fatigue and shortness of breath. Auscultation of the heart reveals the presence of a murmur. What is this assessment finding indicative of? a. Increased viscosity of the patient's blood b. Turbulent blood flow across a heart valve c. Friction between the heart and the myocardium d. A deficit in heart conductivity that impairs normal contractility

B Turbulent blood flow across the affected valve results in a murmur. A murmur is not a direct result of variances in blood viscosity, conductivity, or friction between the heart and myocardium.

A nurse is preparing to teach a group of women in a community volunteer group about heart disease. What should the nurse include in the teaching plan? a. Women are less likely to delay seeking treatment than men. b. Women are more likely to have noncardiac symptoms of heart disease. c. Women are often less ill when presenting for treatment of heart disease. d. Women experience more symptoms of heart disease at a younger age than men.

B Women often have atypical angina symptoms and nonpain symptoms. Women experience the onset of heart disease about 10 years later than men. Women are often more ill on presentation and delay longer in seeking care than men.

A nurse is caring for a client following a coronary artery bypass graft (CABG). Hemodynamic monitoring has been initiated. Which of the following actions by the nurse facilitate correct monitoring readings? (Select all that apply) A. Place the client in high-Fowler's position B. Level transducer to phlebostatic axis C. Zero transducer to room air D. Observe trends in readings E. Compare readings to physical assessment

B, C, D, E B. The level of the transducer should be at the phlebostatic axis (right atrium) to ensure an accurate reading is obtained C. The transducer is zeroed to room air to ensure an accurate reading is obtained. Hemodynamic pressure lines should be calibrated to read atmospheric pressure as zero. D. The trend of the client's pressure reading assists in providing appropriate medical treatment E. Readings are compared to the client's physical assessment findings to evaluate the client's condition and the appropriate treatment provided.

While palpating the arteries of a patient with cardiovascular disease, the nurse rates the force of the pulse as weak. How should the nurse document the assessment finding? A. 0 B. 1+ C. 2+ D. 3+

B. A weak pulse in a patient with cardiovascular disease is indicated by 1+. Absence of a pulse is indicated by 0. A normal pulse rate is indicated by 2+, and 3+ indicates an increased, full, bounding pulse. Text Reference - p. 695

The nurse assesses a patient who is scheduled to undergo a cardiac catheterization. Which question should the nurse ask the patient to ensure safety? A. "Are you lactose intolerant?" B. "Are you allergic to iodine or shellfish?" C. "Do you consume a high-protein diet?" D. "Do you use any form of contraception?"

B. Cardiac catheterization is a diagnostic method used to examine the heart and blood vessels. During this procedure, contrast media such as water-soluble iodine are injected into the patient in order to better see the blood vessels. Therefore, to ensure safety and prevent allergic reactions to the contrast agent, the nurse should ask the patient whether he or she is allergic to iodine. Contrast media do not interact with proteins, so the nurse will not ask whether the patient is consuming a diet rich in protein. Contrast media do not contain lactose and do not worsen the symptoms of lactose intolerance. Contraceptive methods do not reduce the effectiveness of cardiac catheterization. Test-Taking Tip: Identifying content and what is being asked about that content is critical to your choosing the correct response. Be alert for words in the stem of the item that are the same or similar in nature to those in one or two of the options. Text Reference - p. 692

A patient's laboratory report reveals increased creatine kinase (CK-MB) enzymes. The nurse suspects what diagnosis? A. Stroke B. Myocardial infarction (MI) C. Coronary artery disease (CAD) D. Peripheral vascular disease (PVD)

B. Creatine kinase (CK-BB) enzymes are present in the cardiac muscle and are released into the blood due to cell injury. An increase in creatine kinase (CK-MB) enzymes indicates the onset of symptoms of myocardial infarction (MI). Homocysteine is an amino acid produced during protein catabolism; elevated levels of this amino acid are an indication of stroke, coronary artery disease (CAD), and peripheral vascular disease (PVD). Text Reference - p. 698

The patient is confused about how there can be a blockage in the left anterior descending artery (LAD), but there is damage to the right ventricle. The nurse can help the patient understand this with which explanation? A. "The one vessel curves around from the left side to the right ventricle." B. "The LAD supplies blood to the left side of the heart and part of the right ventricle." C. "The right ventricle is supplied during systole primarily by the right coronary artery." D. "It is actually on your right side of the heart, but we call it the left anterior descending vessel."

B. The best response is explaining that the lower portion of the right ventricle receives blood flow from the left anterior descending artery as well as the right coronary artery during diastole.

The nurse is admitting a patient who is scheduled to undergo a cardiac catheterization. What allergy is most important for the nurse to assess before this procedure? A. Iron B. Iodine C. Aspirin D. Penicillin

B. The health care provider usually will use an iodine-based contrast to perform this procedure. Therefore it is imperative to know whether or not the patient is allergic to iodine or shellfish. Knowledge of allergies to iron, aspirin, or penicillin will be secondary. Text Reference - p. 706

The nurse is auscultating the left midclavicular line at the fifth intercostals space (ICS). This is the best location for hearing sounds from which heart valve? A. Aortic B. Mitral C. Tricuspid D. Pulmonic

B. The mitral valve can be assessed by auscultation at the left midclavicular line at the fifth intercostal space (ICS). The aortic area is best heard at the right second intercostal space. Tricuspid area is assessed best at the midleft sternal border. Pulmonic is heard best at the left second intercostal space. Test-Taking Tip: Avoid looking for an answer pattern or code. There may be times when four or five consecutive questions have the same letter or number for the correct answer. Text Reference - p. 697

A patient with a mitral valve disorder will have impaired blood flow between the: A. Vena cava and right atrium B. Left atrium and left ventricle C. Right atrium and right ventricle D. Right ventricle and pulmonary artery

B. The mitral valve is located between the left atrium and the left ventricle. Blood flow would not be impaired between the vena cava and right atrium, right ventricle and pulmonary artery, or right atrium and right ventricle in a patient with mitral valve disorder.

The nurse is admitting a patient who is scheduled to undergo a cardiac catheterization. What allergy is most important for the nurse to assess before this procedure? A. Iron B. Iodine C. Aspirin D. Penicillin

B. The physician will usually use an iodine-based contrast to perform this procedure. Therefore it is imperative to know whether or not the patient is allergic to iodine or shellfish. Knowledge of allergies to iron, aspirin, or penicillin will be secondary.

While auscultating the patient's heart sounds with the bell of the stethoscope, the nurse hears these sounds. How should the nurse document what is heard? A. Diastolic murmur B. Third heart sound (S3) C. Fourth heart sound (S4) D. Normal heart sounds (S1, S2)

B. The third heart sound is heard closely after the S2 and is known as a ventricular gallop because it is a vibration of the ventricular walls associated with decreased compliance of the ventricles during filling. It occurs with left ventricular failure. Murmurs sound like turbulence between normal heart sounds and are caused by abnormal blood flow through diseased valves. The S4 heart sound is a vibration caused by atrial contraction, precedes the S1, and is known as an atrial gallop. The normal S1 and S2 are heard when the valves close normally.

A 55-year-old man with aortic valve stenosis is being admitted for valve replacement surgery. Which assessment finding should the nurse expect? A. Pulse deficit B. Systolic murmur C. Distended neck veins D. Splinter hemorrhages

B. The turbulent blood flow across a diseased valve results in a murmur. Aortic stenosis produces a systolic murmur. A pulse deficit indicates a cardiac dysrhythmia, most commonly atrial fibrillation. Distended neck veins may be caused by right-sided heart failure. Splinter hemorrhages occur in patients with infective endocarditis.

A 59-year-old man has presented to the emergency department with chest pain. What component of his subsequent blood work is most clearly indicative of a myocardial infarction (MI)? A. CK-MB B. Troponin C. Myoglobin D. C-reactive protein

B. Troponin is the biomarker of choice in the diagnosis of MI, with sensitivity and specificity that exceed those of CK-MB and myoglobin. CRP levels are not used to diagnose acute MI.

Auscultation of a patient's heart reveals the presence of a murmur. What is this assessment finding a result of? A. Increased viscosity of the patient's blood B. Turbulent blood flow across a heart valve E. Friction between the heart and the myocardium C. A deficit in heart conductivity that impairs normal contractility

B. Turbulent blood flow across the affected valve results in a murmur. A murmur is not a direct result of variances in blood viscosity, conductivity, or friction between the heart and myocardium.

The nurse does not have information about a patient's typical systolic blood pressure. The nurse is preparing to take the patient's blood pressure using a sphygmomanometer and a stethoscope. What action should the nurse take? A. Replace the cuff on the patient's arm with slightly larger-sized cuff B. Palpate the brachial pulse and inflate the cuff until the pulse ceases C. Apply extra pressure on the cuff manually to measure blood pressure D. Discontinue blood pressure measurement and try to obtain the information within the next hour

B. While measuring blood pressure with the sphygmomanometer and a stethoscope, if systolic blood pressure is not known, then the nurse should palpate the brachial pulse and inflate the cuff until the pulse ceases. Using a larger-sized cuff cannot give accurate results for blood pressure. Applying extra pressure can increase the pressure on the brachial artery, which can give inaccurate test results. When a blood pressure measurement is scheduled, the nurse should be timely and take the patient's blood pressure, using the appropriate technique. Text Reference - p. 690

A nurse is preparing to teach a group of women in a community volunteer group about heart disease. What should the nurse include in the teaching plan? A. Women are less likely to delay seeking treatment than men. B. Women are more likely to have noncardiac symptoms of heart disease. C. Women are often less ill when presenting for treatment of heart disease. D. Women experience more symptoms of heart disease at a younger age than men.

B. Women often have atypical angina symptoms and nonpain symptoms. Women experience the onset of heart disease about 10 years later than men. Women are often more ill on presentation and delay longer in seeking care than men.

A patient has a history of angina and is being treated with nitrates and beta blockers. What important information should the nurse give to the patient regarding sexuality? A. "You cannot have sexual intercourse while taking these medicines." B. "You cannot take medicines like Viagra." C. "Stop taking beta blockers, because they can cause impotence." D. "Stop taking nitrates when planning to have sexual intercourse."

B. he nurse should advise the patient to avoid taking erectile dysfunction (ED) drugs such as Viagra. This is because the combination of ED drugs and nitrates can cause significant hypotension. The patient should not be asked to avoid sex. Beta blockers may cause erectile dysfunction; however, the drug should not be stopped without consulting the primary healthcare provider. Discontinuing nitrates can worsen the angina. Text Reference - p. 694

While assessing a patient for orthopnea, what is an appropriate question for the nurse to ask? A. "How many times do you get up at night to urinate?" B. "How many pillows do you use for sleeping at night?" C. "Do you get awakened by shortness of breath at night?" D. "Are you comfortable while walking as well as talking at the same time?"

B. Patients with heart failure often experience orthopnea. This refers to a condition in which patients may feel the need to sleep with their head elevated and use several pillows to sleep upright. When assessing a patient for nocturia, the nurse asks him how frequently he gets up at night to urinate. When assessing the patient for paroxysmal nocturnal dyspnea, the nurse asks if he wakes up at night due to shortness of breath at night. When checking for shortness of breath during daily activities, the nurse asks the patient whether he is comfortable while walking and talking at the same time. Text Reference - p. 693

The nurse provides discharge instructions for a 40-year-old woman who is newly diagnosed with cardiomyopathy. Which statement, if made by the patient, indicates that further teaching is necessary? A. "I will avoid lifting heavy objects." B. "I can drink alcohol in moderation." C. "My family will need to take a CPR course." D. "I will reduce stress by learning guided imagery."

B. "I can drink alcohol in moderation." Patients with cardiomyopathy should avoid alcohol consumption, especially in patients with alcohol-related dilated cardiomyopathy. Avoiding heavy lifting and stress, as well as family members learning CPR, are recommended teaching points.

A nurse is completing discharge teaching to a client who has heart failure and is encouraged to increase potassium in his diet. Which of the following statements by the client indicates understanding of the teaching? A. "I will consume more white rice." B. "I will eat more baked potatoes." C. "I will drink more grape juice." D. "I will use more powdered cocoa mixes."

B. "I will eat more baked potatoes."

The nurse performs discharge teaching for a 68-year-old man who is newly diagnosed with infective endocarditis with a history of IV substance abuse. Which statement by the patient indicates to the nurse that teaching was successful? A. "I will need antibiotics before having any invasive procedure or surgery." B. "I will inform my dentist about my hospitalization for infective endocarditis." C. "I should not be alarmed if I have difficulty breathing or pink-tinged sputum." D. "An elevated temperature is expected and can be managed by taking acetaminophen."

B. "I will inform my dentist about my hospitalization for infective endocarditis." Patients with infective endocarditis should inform their dental providers of their health history. Antibiotic prophylaxis is recommended for patients with a history of infective endocarditis who have certain dental procedures performed. Antibiotics are not indicated before genitourinary or gastrointestinal procedures unless an infection is present. Patients should immediately report the presence of fever or clinical manifestations indicating heart failure to their health care provider.

The patient had a history of rheumatic fever and has been diagnosed with mitral valve stenosis. The patient is planning to have a biologic valve replacement. What protective mechanisms should the nurse teach the patient about using after the valve replacement? A. Long-term anticoagulation therapy B. Antibiotic prophylaxis for dental care C. Exercise plan to increase cardiac tolerance D. Take β-adrenergic blockers to control palpitations.

B. Antibiotic prophylaxis for dental care The patient will need to use antibiotic prophylaxis for dental care to prevent endocarditis. Long-term anticoagulation therapy is not used with biologic valve replacement unless the patient has atrial fibrillation. An exercise plan to increase cardiac tolerance is needed for a patient with heart failure. Taking β-adrenergic blockers to control palpitations is prescribed for mitral valve prolapse, not valve replacement.

A nurse is caring for a client who has heart failure and reports increased shortness of breath. The nurse increases the oxygen per protocol. Which of the following actions should the nurse take first? A. Obtain the client's weight. B. Assist the client into high-Fowler's position. C. Auscultate lung sounds. D. Check oxygen saturation with pulse oximeter.

B. Assist the client into high-Fowler's position.

The nurse conducts a complete physical assessment on a patient admitted with infective endocarditis. Which finding is significant? A. Respiratory rate of 18 and heart rate of 90 B. Regurgitant murmur at the mitral valve area C. Heart rate of 94 and capillary refill time of 2 seconds D. Point of maximal impulse palpable in fourth intercostal space

B. Regurgitant murmur at the mitral valve area A regurgitant murmur of the aortic or mitral valves would indicate valvular disease, which is a complication of endocarditis. All the other findings are within normal limits.

*The largest percentage of respiratory infections in children are caused by?* A. pneumococci B. viruses C. streptococci D. Haemophilus influenzae

B. Viruses

FAB 9- Folic Acid

B9 (decreases neural tube defects) The client should be taking 3 months before becoming pregnant

uvular edema studden follicles tonsillar exudate fever

Bacterial Pharyngitis Group A Beta Hemolytic stretococci

Does impulse come above or below the ventricle is QRS is larger than .12?

Below

RHF

Blood backs up into right atrium and into system

What 3 tricks to have a child take deep breaths through mouth when auscultating?

Blow out birthday candles/flashlight/pinwheel (also can listen to moms)

What normal breath sound is hollow and higher pitch than vesicular?

Bronchial/tracheal

Which normal breath sound is medium-pitched, hollow, blowing , heard equally on inspiration and expiration, all ages?

Bronchovesicular

Heparin Adverse

Bruising HIT(Heparin Indused Thrombocytopenia)

Bruit, also called vascular murmur,[3] is the abnormal sound generated by turbulent flow of blood in an artery due to either an area of partial obstruction or a localized high rate of blood flow through an unobstructed artery.[4] The bruit may be heard ("auscultated") by securely placing the head of a stethoscope to the skin over the turbulent flow, and listening. Most bruits occur only in systole, so the bruit is intermittent and its frequency dependent on the heart rate. Anything increasing the blood flow velocity such as fever, anemia, hyperthyroidism, or physical exertion, can increase the amplitude of the bruit.

Bruit,

What is the priority assessment by the nurse caring for a patient receiving IV nesiritide to treat heart failure? a. Urine output b. Lung sounds c. Blood pressure d. Respiratory rate

C Although all identified assessments are appropriate for a patient receiving IV nesiritide, the priority assessment would be monitoring for hypotension, the main adverse effect of nesiritide.

The nurse prepares to administer digoxin 0.125 mg to a patient admitted with influenza and a history of chronic heart failure. What should the nurse assess before giving the medication? a. Prothrombin time b. Urine specific gravity c. Serum potassium level d. Hemoglobin and hematocrit

C Serum potassium should be monitored because hypokalemia increases the risk for digoxin toxicity. Changes in prothrombin time, urine specific gravity, and hemoglobin or hematocrit would not require holding the digoxin dose.

When looking at the electrocardiogram (ECG) of the patient, the nurse knows that the QRS complex recorded on the ECG represents which part of the heart's beat? a. Depolarization of the atria b. Repolarization of the ventricles c. Depolarization from atrioventricular (AV) node throughout ventricles d. The length of time it takes for the impulse to travel from the atria to the ventricles

C The QRS recorded on the ECG represents depolarization from the AV node throughout the ventricles. The P wave represents depolarization of the atria. The T wave represents repolarization of the ventricles. The interval between the PR and QRS represents the length of time it takes for the impulse to travel from the atria to the ventricles.

A patient who had bladder surgery 2 days ago develops acute decompensated heart failure (ADHF) with severe dyspnea. Which action by the nurse would be indicated first? a. Perform a bladder scan to assess for urinary retention. b. Restrict the patient's oral fluid intake to 500 mL per day. c. Assist the patient to a sitting position with arms on the overbed table. d. Instruct the patient to use pursed-lip breathing until the dyspnea subsides.

C The nurse should place the patient with ADHF in a high Fowler's position with the feet horizontal in the bed or dangling at the bedside. This position helps decrease venous return because of the pooling of blood in the extremities. This position also increases the thoracic capacity, allowing for improved ventilation. Pursed-lip breathing helps with obstructive air trapping but not with acute pulmonary edema. Restricting fluids takes considerable time to have an effect.

While assessing the cardiovascular status of a patient, the nurse performs auscultation. Which intervention should the nurse implement in the assessment during auscultation? a. Position the patient supine. b. Ask the patient to hold his or her breath. c. Palpate the radial pulse while auscultating the apical pulse. d. Use the bell of the stethoscope when auscultating S1 and S2.

C To detect a pulse deficit, simultaneously palpate the radial pulse when auscultating the apical area. The diaphragm is more appropriate than the bell when auscultating S1 and S2. A sitting or side-lying position is most appropriate for cardiac auscultation. It is not necessary to ask the patient to hold his or her breath during cardiac auscultation.

Vasodilation or vasoconstriction produced by an external cause will interfere with a nurse's accurate assessment of a client with peripheral vascular disease (PVD). Therefore, the nurse should: a) match the room temperature to the client's body temperature. b) maintain room temperature at 78° F (25.6° C). c) keep the client warm. d) keep the client uncovered.

C) keep the client warm. Explanation: The nurse should keep the client covered and expose only the portion of the client's body that she's assessing. The nurse should also keep the client warm by maintaining his room temperature between 68° F and 74° F (20° and 23.3° C). Extreme temperatures aren't good for clients with PVD. The valves in their arteries and veins are already insufficient, and exposing them to vast changes in temperature could affect assessment findings. Keeping the client uncovered would cause him to become chilled. Matching the room temperature to the client's body temperature is inappropriate.

A nurse is assessing the vital signs of a patient admitted to a hospital. Which artery should be used to check the blood pressure? A. Radial B. Carotid C. Brachial D. Femoral

C. Blood pressure is recorded using a device known as a sphygmomanometer and a stethoscope. The ideal and correct site for checking blood pressure is the brachial artery. This artery is on the arm near the elbow. The radial artery is on the wrist. The carotid artery is in the neck region, and the femoral artery is around the groin. Any other site other than the brachial artery is not suitable for checking blood pressure with a sphygmomanometer. Text Reference - p. 690

While assessing the cardiovascular status of a patient, the nurse performs auscultation. Which intervention should the nurse implement in the assessment during auscultation? A. Position the patient supine. B. Ask the patient to hold his or her breath. C. Palpate the radial pulse while auscultating the apical pulse. D. Use the bell of the stethoscope when auscultating S1 and S2.

C. In order to detect a pulse deficit, simultaneously palpate the radial pulse when auscultating the apical area. The diaphragm is more appropriate than the bell when auscultating S1 and S2. A sitting or side-lying position is most appropriate for cardiac auscultation. It is not necessary to ask the patient to hold his or her breath during cardiac auscultation.

The nurse is reviewing basic electrocardiogram (ECG) interpretation. The T wave represents which action? A. Hypokalemia B. Depolarization of the atria C. Repolarization of the ventricles D. Repolarization of the Purkinje fibers

C. On an ECG, the T wave represents repolarization of the ventricles. Depolarization of the atria is represented by the P wave. The U wave, if present, can represent either repolarization of the Purkinje fibers or hypokalemia. Text Reference - p. 704

The nurse observes blanching of a patient's nail beds for two seconds after release of pressure. Which does the nurse recognize as the potential cause of the assessment finding? A. Thyrotoxicosis B. Intermittent claudication C. Reduced arterial capillary perfusion D. Interruption of venous return to heart

C. Reduced arterial capillary perfusion results in a decreased amount of oxygen supply to body parts, which results in blanching of nail beds for two seconds after release of pressure. Hands and feet that are warmer than normal indicate thyrotoxicosis. When the hands and feet are cold to the touch, it indicates intermittent claudication. Visible finger pitting on application of firm pressure indicates interruption of venous return to the heart. Text Reference - p. 696

A nurse is auscultating a patient's heart sounds and hears an S4 heart sound. Which condition may be present? A. Hypertension B. Angina pectoris C. Cardiomyopathy D. Postural hypotension

C. S4 is an extra heart sound caused by atrial contraction. It can be normal in older adults. The common pathologies that cause this sound are cardiomyopathy, left ventricular hypertrophy, atrial stenosis, or coronary artery disease (CAD). Hypertension is increased blood pressure and postural hypotension is a fall in blood pressure after standing, and these conditions do not cause S4. Angina pectoris is pain in the chest region and is not accompanied by S4. Text Reference - p. 697

When looking at the electrocardiogram (ECG) of the patient, the nurse knows that the QRS complex recorded on the ECG represents which part of the heart's beat? A. Depolarization of the atria B. Repolarization of the ventricles C. Depolarization from AV node throughout ventricles D. The length of time it takes for the impulse to travel from the atria to the ventricles

C. The QRS recorded on the ECG represents depolarization from the AV node throughout the ventricles. The P wave represents depolarization of the atria. The T wave represents repolarization of the ventricles. The interval between the PR and QRS represents the length of time it takes for the impulse to travel from the atria to the ventricles.

While assessing the cardiovascular status of a patient, the nurse performs auscultation. Which intervention should the nurse implement to assess the patient's pulse deficit? A. Position the patient supine B. Ask the patient to hold his or her breath C. Palpate the radial pulse while auscultating the apical pulse D. Use the bell of the stethoscope when auscultating S1 and S2

C. To detect a pulse deficit, simultaneously palpate the radial pulse when auscultating the apical area. A sitting or side-lying position is most appropriate for cardiac auscultation. It is not necessary to ask the patient to hold his or her breath during cardiac auscultation. The diaphragm is more appropriate than the bell when auscultating S1 and S2. Test-Taking Tip: Make certain that the answer you select is reasonable and obtainable under ordinary circumstances and that the action can be carried out in the given situation Text Reference - p. 697

A 25-year-old patient with a group A streptococcal pharyngitis does not want to take the antibiotics prescribed. What should the nurse tell the patient to encourage the patient to take the medications and avoid complications of the infection? A. "The complications of this infection will affect the skin, hair, and balance." B. "You will not feel well if you do not take the medicine and get over this infection." C. "Without treatment, you could get rheumatic fever, which can lead to rheumatic heart disease." D. "You may not want to take the antibiotics for this infection, but you will be sorry if you do not."

C. "Without treatment, you could get rheumatic fever, which can lead to rheumatic heart disease." Rheumatic fever (RF) is not common because of effective use of antibiotics to treat streptococcal infections. Without treatment, RF can occur and lead to rheumatic heart disease, especially in young adults. The complications do not include hair or balance. Saying that the patient will not feel well or that the patient will be sorry if the antibiotics are not taken is threatening to the patient and inappropriate for the nurse to say.

A 72-year-old man with a history of aortic stenosis is admitted to the emergency department. He reports severe left-sided chest pressure radiating to the jaw. Which medication, if ordered by the health care provider, should the nurse question? A. Aspirin B. Oxygen C. Nitroglycerin D. Morphine sulfate

C. Nitroglycerin Aspirin, oxygen, nitroglycerin, and morphine sulfate are all commonly used to treat acute chest pain suspected to be caused by myocardial ischemia. However, nitroglycerin should be used cautiously or avoided in patients with aortic stenosis as a significant reduction in blood pressure may occur. Chest pain can worsen because of a drop in blood pressure.

Parasympathetic stimulation of the heart results in: A. Increased heart rate and slower AV conduction B. Increased heart rate and faster AV conduction C. Decreased heart rate and slower AV conduction

C. Parasympathetic stimulation of the vagus nerve causes a decrease in heart rate and slowed AV conduction

What nursing action should the nurse prioritize during the care of a patient who has recently recovered from rheumatic fever? A. Teach the patient how to manage his or her physical activity. B. Teach the patient about the need for ongoing anticoagulation. C. Teach the patient about the need for continuous antibiotic prophylaxis. D. Teach the patient about the need to maintain standard infection control procedures.

C. Teach the patient about the need for continuous antibiotic prophylaxis. Patients with a history of rheumatic fever frequently require ongoing antibiotic prophylaxis, an intervention that necessitates education. This consideration is more important than activity management in preventing recurrence. Anticoagulation is not indicated in this patient population. Standard precautions are indicated for all patients.

*The most likely reason that the respiratory infection rate increases drastically in the age range from 3-6 months is?* A. the infant's exposure to pathogens is greatly increased during this time B. viral agents that are mild in older children are extremely severe in infants C. maternal antibodies have disappeared and the infant's own antibody production is immature D. diameter of the airways is smaller in the infant than in the older child

C. maternal antibodies have disappeared and the infant's own antibody production is immature

*The best way to stimulate deep breathing in a child is to?* A. encourage the child to cover the mouth and suppress the cough B. encourage the child to cough repeatedly C. use games that extend expiratory time and pressure D. leave balloons at the bedside for the child to blow up

C. use games that extend expiratory time and pressure

"open heart surgery"

CABG

open heart sx grafting bv from different bv onto CA rerouting blood around block

CABG

Causes of HF

CAD MI HPT Vavular Disorders Congenital Heart defects Pulmonary Hypertension Cardiomyopathy

HR must not exceed the target rate but should exceed resting HR

CAD Pt.

Most patients remain intubated and on mechanical ventilation for several hours postop

CAR

this this will prevent them from talking, and the nurse should reassure them that the staff will be able to assist pt w/ other means of communication

CAR

PTCA NI post op

CMSTP, site/ s/o bleeding, re occlusion = CP or ST elevation. cardiac rhythm/ v/s, dye, fluids

pharmacologic treatment of HTN

diuretics beta blockers calcium channel blockers ACE inhibitors ARBs

congestive heart failure

CO is insufficient to maintain required blood flow caused by MI, HTN, stenosis results in cariogenic shock treated with digitalis, vasodilators, and diuretics

ACS Systematic assessment includes a careful history as it relates to symptoms: Each symptom must be evaluated with regard to:

CP or disc, palpitations, dypnea, diaphoresis, unusual fatigue syncope time/ duration/ factors that precipitate/ relieve it/ comparison w/ previous s/s

"the pump"

CPB

Operations requiring the opening of the chambers of the heart

CPB

diverts blood away from the heart and lungs temporarily when surgery of the heart and major vessels is performed

CPB

heart-lung machine

CPB

maintains perfusion to body organs and tissues during prcdr

CPB

oxygenating Heart and lung pump machine

CPB

requires the absence of blood from the surgical field

CPB

^ resp efficiency, expansion of lungs, strengthening resp muscles and eliminating secretions

CPT

indications: patients who have acute or chronic respiratory problems: inability to expel secretions, ineffective cough, swallowing difficulties

CPT

use of postural drainage in combo w/ techniques to ^ airway clearance

CPT

Clearance of pulmonary secretions is accomplished by

CPT , repositioning suctioning, and , ed. to ^ cough/ deep breathing

decreases SA node automaticity and AV node conduction, = decreases HR = decrease in the strength of the heart muscle contraction.

Ca+ channel blockers

Antidote for Mag Sulfate

Calcium Gluconate

Textbook Critical Thinking and Prioritization Questions 1. A patient who was admitted to the hospital for treatment of atrial fibrillation is about to go home with a new prescription for diltiazem (Cardizem). As the nurse goes over the patient's medication list, the patient complains, "I'm feeling very tired. And when I stand up, I can hardly walk because I'm so dizzy." What is the nurse's priority action at this time?

Calcium channel blockers may cause bradycardia, heart block, hypotension, and dizziness. The nurse's priority action is to assess the patient's vital signs, including apical pulse and postural blood pressure. It is possible that the patient is experiencing orthostatic changes when he stands up. The nurse will need to teach the patient to sit upright before standing up from a reclining position and to stand up slowly.

bleeding from PCI femoral region

Call for help first. The femoral sheath produces pressure on the access site. Pressure will temporarily reduce bleeding and allow for following NI. Removing the sheath would exacerbate bleeding and repositioning would not halt it.

Iggy Ch.32 p. 610, Patient-Centered Care; Safety; Evidence-Based Practice The patient is a 70-year-old retiree who had a hip replacement 2 days ago. His hip pain kept him from participating in his usual exercise program for the past 6 months. He is a former two-pack a day smoker. At home he decreased his fluid intake because ambulating to the bathroom was so painful. He resisted getting out of bed with physical therapy yesterday. When you assess him this morning, he reports nausea, some chest pain, mild shortness of breath, and anxiety. 5. What other actions should you take?

Call the rapid response team. Continuously monitor his cardiac and respiratory status. Prepare to start an IV line.

Automaticity

Capacity to initiate an impulse or stimulus

Digoxin

Cardiac Glycoside

Specialized Cells

Cardiac cells that comprise the conduction system (where the electrical activity preceding mechanical activity occurs)

Myocardial Cells

Cardiac cells that have the property of contractility

Cardiac risk factors for A-fib include:

Cardiac risk factors include: long-standing hypertension, ischemic heart disease, CHF, all forms of carditis, cardiomyopathy, all types of infiltrative heart disease and sick sinus syndrome

machine takes over function of heart/ lungs during Sx maintaining blood circulation and o2 to pts body. CPB pump is often referred to as heart-lung machine or "the pump"

Cardiopulmonary bypass

Hypermagnesemia

Caused by: renal failure & antacids s/s: flushed, warm, decreased DTR, decreased muscle tone, arrhythmia, decreased LOC, decreased pulse, decreased respirations

Hypercalcemia

Causes: too much PTH, Thiazides (retain Ca) Immobilization s/s: brittle bones, kidney stones tx: fluids for kidney stones, PhosphoSoda & Fleet Enema (have Ph; Ca & Ph have inverse relationship), steroids (decrease serum Ca), add Ph to diet, MUST have VITAMIN D, Calcitonin (decreases serum Ca, used for Osteoporosis)

What is resting potential?

Cell membranes separate different concentrations of ions such as sodium and potassium and create a more negative charge inside the cell

Herbals tha tinterfere with anticoagulants

Chamomile Garlic Ginger Ginko Glucosamine Green leaf tea

Ventricular fibrillation (v-fib) does what??

Chaotic pattern of electrical activity in the ventricles in which the electrical impulses arise from many different foci. It produces no effective muscular contraction and no cardiac output. Ventricular fibrillation is a medical emergency that requires prompt Advanced Life Support interventions. If this arrhythmia continues for more than a few seconds, it will likely degenerate further into asystole

Transvenous Pacemaker Nursing care and intervention:

Check rhythm hourly Watch for loss of capture Risk for bleeding and infection Keep patient in bed so pacing wire does not float out of endocardium Check pacer settings hourly

p. 614, Patient-Centered Care; Teamwork and Collaboration A 50-year old patient is admitted to the medical-surgical floor from the emergency department with severe abdominal pain thought to be from acute pancreatitis. He has a history of drinking at least a case of beer a day. He also smokes and appears cachectic. His old chart indicates a history of COPD, but he does not take medications for this. He does have a new productive cough. At change of shift, the nurse finds the patient dyspneic and slightly confused. Lung sounds have wheezes, and he is mildly febrile. Pulse is 120 beats/min, respirations are 32 breaths/min, and blood pressure is 118/64 mm Hg (baseline). Oximetry shows an SPO2 of 91%. 3. What diagnostic testing should you be prepared to obtain?

Chest radiography is needed for diagnosis and comparison with later tests. An arterial blood gas analysis is needed both before and after oxygen therapy to determine the alveolar oxygen gradient and the degree of true hypoxemia. Sputum cultures are needed to rule out a lung infection. Depending on the severity of his dyspnea, he may need invasive hemodynamic monitoring.

Phenothiazine drugs

Chlorpromaine (Thorazine) prochlorperazine (Compazine) trifluoperazine (stelline) promethazine (phenergan) hydroxyzine (vistaril) fluphenazine (prolixin)

Benzo's

Clonazepam (Klonopin) Diazepam (valium) chlordiazepoxide (librium) lorazepam (ativan) flurazepam (daimane)

Liver disease

Clotting factors not being produced and proteins needed for clotting

Digoxin Toxicity Signs

Color change with green, yellow, purple, halo vision and flickering lights

Iggy Ch.32 p. 610, Patient-Centered Care; Safety; Evidence-Based Practice The patient is a 70-year-old retiree who had a hip replacement 2 days ago. His hip pain kept him from participating in his usual exercise program for the past 6 months. He is a former two-pack a day smoker. At home he decreased his fluid intake because ambulating to the bathroom was so painful. He resisted getting out of bed with physical therapy yesterday. When you assess him this morning, he reports nausea, some chest pain, mild shortness of breath, and anxiety. 3. What are the common manifestations of PE?

Common manifestations of PE include (but are not limited to): Dyspnea Pleuritic chest pain Crackles and wheezes on chest auscultation Pleural friction rub Tachycardia Distended neck veins Syncope Cyanosis Hypotension Abnormal heart sounds

Valves of the heart are?

Contains four valves Two atrial-ventricular valves: tricuspid and mitral Two semi-lunar valves: aortic and pulmonic

Angiotensinogen

Converted to angiotensin I by renin

LHF manifestations

Cool Clamy Dyspnea Orthopnea Tachypnea Pink frothy Sputum

In most cases angina pectoris is due to

Coronary arteriosclerosis

When a person's blood pressure rises, the homeostatic mechanism to compensate for an elevation involves stimulation of: a. baroreceptors that inhibit the sympathetic nervous system causing vasodilation b. chemoreceptors that inhibit the sympathetic nervous system causing vasodilation c. baroreceptors that inhibit the parasympathetic nervous system causing vasodilation d. chemoreceptors that stimulate the sympathetic nervous system causing an increased heart rate

Correct answer: a Rationale: Baroreceptors in the aortic arch and carotid sinus are sensitive to stretch or pressure within the arterial system. Stimulation of these receptors sends information to the vasomotor center in the brainstem. This results in temporary inhibition of the sympathetic nervous system and enhancement of the parasympathetic influence, causing a decreased heart rate and peripheral vasodilation.

The portion of the vascular system responsible for hemostasis is the: a. thin capillary vessels b. endothelial layer of the arteries c. elastic middle layer of the veins d. smooth muscle of the arterial wall

Correct answer: b Rationale: The innermost lining of the arteries is the endothelium. The endothelium maintains hemostasis, promotes blood flow, and under normal conditions, inhibits blood coagulation.

Too much Aldosterone

Cushing's Cohn's (hyperaldosteronism)

Which instruction by the nurse is given to a patient who is about to undergo Holter monitoring is most appropriate? a. "You may remove the monitor only to shower or bathe." b. "You should connect the monitor whenever you feel symptoms." c. "You should refrain from exercising while wearing this monitor." d. "You will need to keep a diary of all your activities and symptoms."

D A Holter monitor is worn continuously for at least 24 hours while a patient continues with usual activity and keeps a diary of activities and symptoms. The patient should not take a bath or shower while wearing this monitor.

The blood pressure of an older adult patient admitted with pneumonia is 160/70 mm Hg. What is an age-related change that contributes to this finding? a. Stenosis of the heart valves b. Decreased adrenergic sensitivity c. Increased parasympathetic activity d. Loss of elasticity in arterial vessels

D An age-related change that increases the risk of systolic hypertension is a loss of elasticity in the arterial walls. Because of the increasing resistance to flow, pressure is increased within the blood vessel, and hypertension results. Valvular rigidity of aging causes murmurs, and decreased adrenergic sensitivity slows the heart rate. Blood pressure is not raised. Increased parasympathetic activity would slow the heart rate.

The nurse is administering a dose of digoxin to a patient with heart failure (HF). The nurse would become concerned with the possibility of digitalis toxicity if the patient reported which symptom? a. Muscle aches b. Constipation c. Pounding headache d. Anorexia and nausea

D Anorexia, nausea, vomiting, blurred or yellow vision, and cardiac dysrhythmias are all signs of digitalis toxicity. The nurse would become concerned and notify the health care provider if the patient exhibited any of these symptoms.

A patient is scheduled for a heart transplant. Beyond the first year after a heart transplant, the nurse knows that what is a major cause of death? a. Infection b. Acute rejection c. Immunosuppression d. Cardiac vasculopathy

D Beyond the first year after a heart transplant, malignancy (especially lymphoma) and cardiac vasculopathy (accelerated coronary artery disease) are the major causes of death. During the first year after transplant, infection and acute rejection are the major causes of death. Immunosuppressive therapy will be used for posttransplant management to prevent rejection and increases the patient's risk of an infection.

A patient is admitted with severe dyspnea, a history of heart failure, and chronic obstructive lung disease. Which diagnostic study would the nurse expect to be elevated if the cause of dyspnea was cardiac related? a. Serum potassium b. Serum homocysteine c. High-density lipoprotein d. b-type natriuretic peptide (BNP)

D Elevation of BNP indicates the presence of heart failure. Elevations help to distinguish cardiac versus respiratory causes of dyspnea. Elevated potassium, homocysteine, or HDL levels may indicate increased risk for cardiovascular disorders but do not indicate that cardiac disease is present.

The nurse informs the patient that she must wear intermittent sequential compression stockings after a surgical procedure. What is an appropriate rationale for nurse to give to the patient for the use of the device? a. The socks keep the legs warm while the patient is not moving much. b. The socks maintain the blood flow to the legs while the patient is on bed rest. c. The socks keep the blood pressure down while the patient is stressed after surgery. d. The socks provide compression of the veins to keep the blood moving back to the heart.

D Intermittent sequential compression stockings provide compression of the veins while the patient is not using skeletal muscles to compress the veins, which keeps the blood moving back to the heart and prevents blood pooling in the legs that could cause deep vein thrombosis. The warmth is not important. Blood flow to the legs is not maintained. Blood pressure is not decreased with the use of intermittent sequential compression stockings.

On admission to the emergency department, a patient with cardiomyopathy has an ejection fraction of 10%. On assessment, the nurse notes bilateral crackles and shortness of breath. Which additional assessment finding would most indicate patient decline? a. Increased heart rate b. Increased blood pressure c. Decreased respiratory rate d. Decreased level of consciousness

D Patients with mechanical valve replacement are placed on anticoagulants and should be in a therapeutic INR range of 2.5 to 3.5. Administration of Coumadin (Warfarin) prolongs clotting time and prevents clot formation on the valve. The low INR would require a call to the healthcare provider for an order increase the medication dose. Vital signs would be unchanged related to the low INR. Intravenous fluids are not indicated. The patient is at risk of forming clots, not bleeding.

A patient with a long-standing history of heart failure recently qualified for hospice care. What measure should the nurse now prioritize when providing care for this patient? a. Taper the patient off his current medications. b. Continue education for the patient and his family. c. Pursue experimental therapies or surgical options. d. Choose interventions to promote comfort and prevent suffering.

D The central focus of hospice care is the promotion of comfort and the prevention of suffering. Patient education should continue, but providing comfort is paramount. Medications should be continued unless they are not tolerated. Experimental therapies and surgeries are not commonly used in the care of hospice patients.

An asymptomatic patient with acute decompensated heart failure (ADHF) suddenly becomes dyspneic. Before dangling the patient on the bedside, what should the nurse assess first? a. Urine output b. Heart rhythm c. Breath sounds d. Blood pressure

D The nurse should evaluate the blood pressure before dangling the patient on the bedside because the blood pressure can decrease as blood pools in the periphery and preload decreases. If the patient's blood pressure is low or marginal, the nurse should put the patient in the semi-Fowler's position and use other measures to improve gas exchange.

A 74-year-old woman who is admitted with severe dyspnea has a history of heart failure and chronic obstructive lung disease. Which diagnostic study would the nurse expect to be elevated if the cause of dyspnea was cardiac related? A. Serum potassium B. Serum homocysteine C. High-density lipoprotein D. b-type natriuretic peptide (BNP)

D. Elevation of b-type natriuretic peptide (BNP) indicates the presence of heart failure. Elevations help to distinguish cardiac vs. respiratory causes of dyspnea. Elevated potassium, homocysteine, or HDL levels may indicate increased risk for cardiovascular disorders but do not indicate that cardiac disease is present.

On return from surgery, the patient is wearing intermittent sequential compression stockings that he does not want to keep on. How should the nurse explain their necessity to the patient while he is on bed rest? A. The socks keep the legs warm while the patient is not moving much. B. The socks maintain the blood flow to the legs while the patient is on bed rest. C. The socks keep the blood pressure down while the patient is stressed after surgery. D. The socks provide compression of the veins to keep the blood moving back to the heart.

D. Intermittent sequential compression stockings provide compression of the veins while the patient is not using skeletal muscles to compress the veins, which keeps the blood moving back to the heart and prevents blood pooling in the legs that could cause deep vein thrombosis. The warmth is not important. Blood flow to the legs is not maintained. Blood pressure is not decreased with the use of intermittent sequential compression stockings.

The nurse is performing cardiac assessment on several patients. The nurse recognizes that the sympathetic nervous system is stimulated in the patient that has what heart rate? A. Heart rate of 50 beats/minute. B. Heart rate of 70 beats/minute. C. Heart rate of 80 beats/minute. D. Heart rate of 110 beats/minute.

D. Stimulation of the sympathetic nervous system increases heart rate. The normal heart rate is in the range of 60 to 100 beats/minute. Therefore, the patient with heart rate of 110 beats/minute has a stimulated sympathetic nervous system. Stimulation of the sympathetic nervous system does not decrease the patient's heart rate. Therefore, the heart rate of 50 beats/minute does not indicate stimulation of the patient's sympathetic nervous system. The heart rates of 70 and 80 beats/minute are normal findings and do not indicate stimulation of the patients' sympathetic nervous systems. Text Reference - p. 690

Which statement regarding the anatomical characteristics of the heart is true? A. The right and the left atria are similar in size. B. The atrial myocardium is thicker than that of the ventricles. C. The right ventricular wall is three times thicker than the left ventricular wall. D. The thickness of the left ventricle is necessary to pump the blood into the systemic circulation.

D. The left ventricle is thicker because it needs to pump the blood into circulation. The right and left atria are different sizes and have different wall thicknesses. The atrial myocardium is thinner than that of the ventricles. The left ventricular wall is two or three times thicker than the right ventricular wall. Test-Taking Tip: Identify option components as correct or incorrect. This may help you identify a wrong answer. Text Reference - p. 687

A nurse is orienting a newly licensed nurse on the care of a client who is receiving hemodynamic monitoring. Which of the following statements by the newly licensed nurse indicates the teaching was effective? A. "Air should be instilled into the monitoring system." B. "The client should be in the prone position." C. "The transducer should be level with the 2nd intercostal space" D. "A chest X-ray is needed to verify placement."

D. A chest x-ray is obtained to confirm proper placement of the lines

A 55-year-old female patient develops acute pericarditis after a myocardial infarction. It is most important for the nurse to assess for which clinical manifestation of a possible complication? A. Presence of a pericardial friction rub B. Distant and muffled apical heart sounds C. Increased chest pain with deep breathing D. Decreased blood pressure with tachycardia

D. Decreased blood pressure with tachycardia Cardiac tamponade is a serious complication of acute pericarditis. Signs and symptoms indicating cardiac tamponade include narrowed pulse pressure, tachypnea, tachycardia, a decreased cardiac output, and decreased blood pressure. The other symptoms are consistent with acute pericarditis.

A nurse is teaching a client the importance of remaining still following angiography. Which of the following is an appropriate statement by the nurse? A. "Moving in bed raises your blood pressure." B. "Too much activity increases your risk for infection." C. "Moving in bed increases your risk of a complication due to anesthesia." D. "Too much activity places you at risk for bleeding."

D. Following angiography, it is important that the client lie still due to the increased risk for bleeding at the insertion site.

The patient with pericarditis is complaining of chest pain. After assessment, which intervention should the nurse expect to implement to provide pain relief? A. Corticosteroids B. Morphine sulfate C. Proton pump inhibitor D. Nonsteroidal antiinflammatory drugs

D. Nonsteroidal antiinflammatory drugs Nonsteroidal antiinflammatory drugs (NSAIDs) will control pain and inflammation. Corticosteroids are reserved for patients already taking corticosteroids for autoimmune conditions or those who do not respond to NSAIDs. Morphine is not necessary. Proton pump inhibitors are used to decrease stomach acid to avoid the risk of GI bleeding from the NSAIDs.

*The nurse should know that the early subtle indication of hypoxia is?* A. peripheral cyanosis B. central cyanosis C. hypotension D. mood changes and restlessness

D. mood changes and restlessness

Venous Thromboembolic Disorders

DVT Pulmonary Embolism

Diameter of a child's trachea approximates the diameter of the child's __________.

Diameter of a child's trachea approximates the diameter of the child's *little finger.*

EKG Paper: Rule of 300

Divide 300 by the number of big boxes between each QRS: The result will be approximately equal to the rate

Antidote for Digoxin

Digibind

Schedule 5

Dispensed as any other prescription or without prescription

Iggy Ch.32 p. 610, Patient-Centered Care; Safety; Evidence-Based Practice The patient is a 70-year-old retiree who had a hip replacement 2 days ago. His hip pain kept him from participating in his usual exercise program for the past 6 months. He is a former two-pack a day smoker. At home he decreased his fluid intake because ambulating to the bathroom was so painful. He resisted getting out of bed with physical therapy yesterday. When you assess him this morning, he reports nausea, some chest pain, mild shortness of breath, and anxiety. 4. The patient is requesting something for his anxiety. Is this appropriate at this time? Why or why not? How else might you be able to reduce his anxiety?

Do not administer any drug for anxiety. Most are sedating and could interfere with his respiratory efforts and his ability to cooperate with interventions. Acknowledge his anxiety and speak to him calmly and clearly. Explain everything you are doing or providing. Continue to reassure him that all appropriate measures are being taken.

Beta agonists used in acute congestive heart failure

Dobutamine and dopamine

Hemorrhagic Disrder

Dosiorder with excessive bleeding Hemophilia Liver disease bone marrow disorders Von Willebrand Disease

26. Angina pectoris is chest pain resulting from myocardial

ischemia

T inversion

ischemia

Cilostazol

Drug used for Intermittent claudication

Pentoxifylline

Drug used for Intermittent claudication

T wave inversion suggests:

ischemia

What occurs during diastole?

During diastole, the ventricles relax, the atria contract, and blood is forced through the open tricuspid valve; the aortic and pulmonic valves are closed

What happens during one heart beat?

During one heart beat ventricular diastole (relaxation) and ventricular asystole (contraction) occur

Supernormal Period

During this period the cardiac cells will respond to a weaker than normal stimulus (just before the cells have completely repolarized.

shaggy white, purple tonsil exudate marked LAD 90% tx ? diag?

EBV mono pharyngitis prodromal of fever and malaise test: monospot for + hetrophill AVOID - amoxicillin= rash

EKG Paper: Each small box/square is ______ seconds

Each small box/square is *0.04* seconds ---Therefore, 5 small boxes/squares across equals .20 seconds

EKG Paper: Each small box/square is ______ mV

Each small box/square is *0.1* mV ----Therefore, 5 small boxes/squares tall equal .5 millivolts mV

S/S of clotting sdisorders

Easy Bruising Petechiae Fecal Blood Occult Bleeding from surgical wounds

Proton pump inhibitors

Esomeprazole (nexium) lansoprazole (prevacid) pantoprazole (protonix) rabeprazole (aciphex)

Apixaban

Factor Xa inhibitor

Edoxaban

Factor Xa inhibitor

alkaline phosphate

Evaluates live and bone function *NPO 8-12 hrs *List meds client is taking on lab slip *units/L* up to 104 (I & Adole) 50-120 (A)

BUN

Evaluates renal function *mg/dL* 7-18 ; 8-20 (>60)

Excitability results from...?

Excitability results from ion shifts across the cell membrane

Etiology of Sinus Tachycardia

Exercise Pain Fever CHF Shock Agitation illicit drugs(cocaine) caffeine nicotine

Bachmann's Bundle extend from.......

Extend from SA node to the left atrium

Risk factors for Venous Thromboembolic Disorder

Extended immobility Major Trauma Major Surgery Hypercoaguability Estrogen Therapy

34. (T/F) In systolic heart failure, decreased cardiac output causes the kidney to release renin to initiate vasoconstriction in an effort to increase blood flow.

F

Diabetes Insipidus

FVD shock urine diluted blood concentrated

Gallbladder disease risk factors

Fair, fat, forty, five pregnancies, flatulent

13. (T/F) Lifestyle changes/modifications have not been proven to control hypertension.

False

14. (T/F) Using a blood pressure cuff that is too small will give a lower blood pressure measurement compared to one taken with a properly sized cuff.

False

25. (T/F) A desirable LDL level for patients with a diagnosis of coronary artery disease 160 mg/dL.

False

36. (True/False) When there are two rescuers during CPR, the first person pauses after every 15 cardiac compression to permit the second person to give one ventilation.

False

What is normal rate for respiration's??

Faster, increased metabolic rate and need for oxygen?

Purkinje Fibers

Fibers that are present at the termination of the bundle branches, which conduct electrical impulses into the myocardial muscle of the ventricles. Rate 20-40 BPM

Tonsilectomy risk for bleeding times

First 24 hrs 5-10 days post-op (scabs fall off)

Antidote for Benzodiazepines

Flumazenil

QRS wave =

Follows the P wave and represents *depolarization of the ventricles* Normal QRS: Follows PR interval *5-30 mm high* *.06-.12 seconds*

Major problem with PO K+?

GI upset; five with food

Anti infective drugs

Genatmicin (geramycin) Kanamycin (kantrex) neomycin (mycifradin) streptomycin (streptomycin) tobramycin (tobrex) amikacin (amikin)

P wave inversion is indicative of

ischemia to myocardium

What should you do if you view artifact on an ECG?

Get eyes on the patient!

commonly occur when nitroglycerin is taken at the beginning of therapy.

Headache and dizziness

Antidote for Beta-blockers

Glucagon

p. 614, Patient-Centered Care; Teamwork and Collaboration A 50-year old patient is admitted to the medical-surgical floor from the emergency department with severe abdominal pain thought to be from acute pancreatitis. He has a history of drinking at least a case of beer a day. He also smokes and appears cachectic. His old chart indicates a history of COPD, but he does not take medications for this. He does have a new productive cough. At change of shift, the nurse finds the patient dyspneic and slightly confused. Lung sounds have wheezes, and he is mildly febrile. Pulse is 120 beats/min, respirations are 32 breaths/min, and blood pressure is 118/64 mm Hg (baseline). Oximetry shows an SPO2 of 91%. 4. What additional measures do you anticipate for this patient?

He will at least need continuous positive airway pressure ventilation or may require intubation with mechanical ventilation and positive end-expiratory pressure to keep oxygen saturation adequate.

Equation to get the Cardiac Output is?

Heart rate (HR) x Stroke volume (SV)= Cardiac Output (CO)

Etiology of Atrial Fibrillation

ischemic heart disease hypoxemia hyperthyroidism valvular disease

disease in which the adrenal gland(s) make too much aldosterone which leads to hypertension and low blood K+. Primary hyperaldosteronism can be caused by either hyperactivity in one adrenal gland (unilateral disease) or both (bilateral disease).

Hyperaldosteronism

Lilley Ch.26 pg. Textbook Case Studies In the past 2 years, Mr. L., a 56-year-old architect, has experienced three episodes of deep vein thrombosis. All occurred without complications, and all were treated successfully with anticoagulant therapy and bed rest. He now arrives at the urgent care center because of increased pain and swelling in his left calf that has lasted for the past 3 days. On admission to the hospital for anticoagulant therapy, Mr.L. receives a bolus of 5000 units of heparin and is started on a continuous heparin infusion. 4. What went wrong? How could this error have been prevented?

In this case, the "right dose" was not given. Prevent medication errors by following the "Six Rights"! In addition, as with all medications, check the label three times before giving it. Did the nurse follow the health care institution protocol by checking the dose with another nurse? Heparin vials come in a variety of concentrations per mL and it is important to ensure that the correct dose is administered.

Systolic HF

Inability for heart to pump blood forward Caused by mechanical abnormalities, increased afterload, or impaired contractile function **Decreased Ejection Fraction is hallmark of Systolic HF. Normal EF s 55-60%

Diastolic HF

Inability of heart to relax and fill

aspartate aminotransferase (aka SGOT)

Increase liver disease, hepatitis *Units* 10-40

S&S of Post-Op Hemorrhage

Increased pulse temp andrestlessness

Infants airway is approx ___mm in diameter -size of a _________. -adult airway is _____mm

Infants airway is approx *4 mm* in diameter -size of a *drinking straw* -adult airway is *20mm*

*Pediatric Lower Airway* ___________ muscle immature, ribs cartilage, flexible, ________ ventilation.

Intercostals muscle immature, ribs cartilage, flexible, inefficient ventilation

Morphine and Angina

Intravenous morphine sulfate is used appropriately for many patients presenting with an ACS, who continue to have symptoms related to myocardial ischemia (usually chest pain) despite aggressive therapy with nitrates, β‐blockers, and angiotensin‐converting enzyme inhibitors (ACEI). Unfortunately, many patients with an ACS who have not been treated aggressively, or who just complain of chest pain of uncertain etiology and oftentimes of noncardiac etiology, are given intravenous morphine to relieve their pain.

Preop ed is an important part of the nsg care of pts having CAR. When explaining the pre/ postop regimens, you would be sure to include ed about

Intubation and mechanical ventilation

Mycin drugs an cause _____ or ______

ototoxicity or nephrotoxicity *check BUN & creatinine* *monitor for hearing loss*

CAD in women

post menopause = 2-3 times more likely than pre men esp if coupled w/ DM HTN or inactivity

Second Degree A-V Block (Type II)

LETHAL DYSRHYTHMIA

Second Degree A-V Block (Type II)

LETHAL DYSRHYTHMIA

Third Degree A-V BlockComplete Heart Block (CHB)

LETHAL DYSRHYTHMIA

Vtach

LETHAL DYSRYTHMIA

systolic heart failure results in failure where

LV

Hemophilia

Lack of Clotting factors

Small tumors occurring in the larynx

Laryngeal papillomatosis

Cr normal

Less than 1.5 mg/dL

LDL cholesterol

Less than 140

plaque on the inner lumen of arteries is composed chiefly of what

Lipids and fibrous tissue

Lungs rely on ________ and _________ for respiration.

Lungs rely on *diaphragm and intercostals muscles* for respiration

ST elevation

MI

Etiology of Vtach

MI hypoxemia acidosis low potassium Digitalis and catecholamines

Pseudoephedrine, phenylephrine

MOA: Sympathomimetic alpha-agonist--nonprescription nasal decongestant Use: Reduce hyperemia, edema, and nasal congestion; open obstructed eustachian tubes. Can be used to make methamphetamine a/e : HTN CNS stimulation/anxiety

-complication of an form of shock due to inadequate tissue perfusion -failure of 2 or more organ systems -end result if shock isn't stopped

MODS

Complication of any form of shock. Organs failing. Need at least two systems affected. Normally, a progression. Usually, CNS last. Heart and lungs are first to fail. Decreased perfusion is causing this. Most common with septic shock when it progresses. Cannot really predict this, but older pt, malnutr, or co-morbidities are more likely to have this.

MODS

U Wave

May or may not be visible. Found after T wave. Prominent upright U waves are abnormal and can mean hypokalemia

What is Pulseless Electrical activity?

May show rhythm but no pulse or BP Common after Defibrillation

Duration

Measured on the horizontal axis by a series of vertical lines; the interval between vertical lines equals 0.04 second

Voltage

Measured on the vertical axis by a series of horizontal lines that are 1 mm apart

The valve from the left atrium to the left ventricle is referred to as?

Mitral valve

MVS is abbreviated for

Mitral valve stenosis

Nursing care and interventions after placement of permanent pacemaker

Monitor vital signs and for arrhythmias Monitor urine output and LOC Monitor rhythm hourly Monitor for chest pain or other client complaints such as dizziness, pain, diaphoresis, bleeding, increased temperature, weak pulses Keep left arm in sling for 24 hours (prevents movement of leads)

GTT 1hr

More than 190

Atrial Fibrillation (afib)

Most common arrhythmia found in clinical practice Increases the risk of death by 1.5-1.9 times AF is defined by the absence of coordinated atrial systole. In AF, multiple reentrant electrical wavelets move randomly around the atria replacing the normal atrial contractory P waves with irregular, chaotic fibrillatory waves.

Isotonic (crystalloid) solutions

NS (0.9) LR D5w D51/4NS *used when administering blood* *Do not use in cardiac or renal disease*

Cardiac Markers

Myoglobin, CK-MB, Troponin, B-Type Natiuretic Peptide (BNP), Aspartate transaminase (AST), Lactate dehydrogenase (LD)

When you see Na+, think

NEURO CHANGES

UA

New-onset angina Variant (Prinzmetal's) angina Pre infarction angina Patients present with ST changes on 12-lead ECG, but will not have changes in troponin or CK levels

Hindu religious considerations

No beef or items containing gelatin

S/S Pulseless electrical Activity

No pulse no BO o respirations cyanosis death

Non-cardiovascular risk factors for A-fib include:

Non-cardiovascular risk factors include advanced age, history of stroke, hyperthyroidism, low electrolyte levels (potassium, magnesium and calcium), pheochromocytoma, illicit drug and alcohol use, diabetes, electrocution, hypothermia and idiopathic

Amlodipine aka (Norvasc) is a

Norvasc ca+ channel blocker

Late decelerations

Occur after the peak of contraction and mirror the contraction in length and intensity. Caused by placental insufficiency. Intervention: change position of mother; if piton is infusing, stop the infusion; apply oxygen, increase rate of IV infusion. Contact HCP if problem persists

Premature ventricular contractions (PVC)

On EKG, there is an early wide QRS complex with no associated P wave. After that beat, there is a slight pause, and then a normal rhythm continues

The nurse teaches a caregiver about the plan of care for an elderly patient with orthostatic hypotension. Which action by the caregiver will be most beneficial to the patient? A. Monitoring for the risk of falls B. Encouraging laughter therapy C. Encouraging treadmill exercises D. Taking the patient out for recreation

Orthostatic hypotension, or postural hypotension, is low blood pressure that occurs in patients when they stand up from sitting or lying down. Patients with orthostatic hypotension are an increased risk of falls. Therefore, the caregiver should monitor for falls in the patient. The caregiver can encourage laughter therapy and treadmill exercises, but these measures are not as beneficial as monitoring the patient for falls. The caregiver can take the patient out for recreation, but it is not as beneficial as monitoring the patient's risk of falls. Text Reference - p. 691

few changes to ___ waves occur during or after an MI

P

First degree block

P wave precedes each QRS - complex but interval is >0.2 sec. PR interval fixed and > 0.2 sec

Common etiology of Paroxysmal Supraventricular Tachy

PACs usually will cause a run of PSVT atrial stretch(seen in valve disease, CHF, liver disease, pulmonary hypertension.) mitral valve prolapse emotional upheaval nicotine caffeine DIGOXIN

point of apex that touches ACW where heart is easily observed and palpated

PMI

Normal Sinus Rhythm (NSR)

PP interval (rhythm)- regular RR interval (rhythm)- regular PP rate- 60-100/min RR rate- 60-100/min P wave- upright in lead II PRI- 0.12-0.20 second QRS interval- less than 0.12 second

determines a client's response to oral anticoagulant therapy. This test measures the time required for a fibrin clot to form in a citrated plasma sample following addition of calcium ions and tissue thromboplastin and compares this time with the fibrin-clotting time in a control sample. The physician should adjust anticoagulant dosages as needed, to maintain PT at 1.5 to 2.5 times the control value. Bleeding time indicates how long it takes for a small puncture wound to stop bleeding. The platelet count reflects the number of circulating platelets in venous or arterial blood. PTT determines the effectiveness of heparin therapy and helps physicians evaluate bleeding tendencies.

PT

Coumadin (warfarin) monitoring

PT (10-12 sec) *bleeding time should be 1.5-2x the control* Antidote: Vitamin K

99% of bleeding disorders are dx'd by

PT and PTT's

Measures of Clotting function

PT/INR aPTT Anti XA(heparin Platlet Counts Liver Function Tests

minimally invasive procedure = opens up blocked coronary arteries, allowing unobstructed blood to circulate to myocardium

PTCA

minimally invasive procedure that allows unobstructed blood to circulate to the coronary arteries heart muscle

PTCA

procedure to open up blocked coronary arteries

PTCA

nsg care preprocedure: allergies?, informed consent, shave prep, IV, teaching. post: check site for bleeding, VS, check for re occlusion (chest pain or ST elevation again), dye reaction, cardiac rhythm, encourage fluids, circulation checks

PTCA NI

CMSTP, site/ s/o bleeding, re occlusion = CP or ST elevation. cardiac rhythm/ v/s, dye, fluids

PTCA NI post procedure

allergies consent IV shave prep teaching

PTCA NI pre op

Heparin/Lovenox/Dalteparin monitoring

PTT (30-45 sec) *bleeding time should be 1.5-2x the control* Antidote: Proteamine Sulfate

Signs of decreased cardiac output

Pale, cold, clammy sycopal, lethargic slow cap refill, decrease pulses parasthesias, numb decrease LOC, decrease orientation Tachypnic, dyspnic, decerase o2 sats decrease urine output

p. 614, Patient-Centered Care; Teamwork and Collaboration A 50-year old patient is admitted to the medical-surgical floor from the emergency department with severe abdominal pain thought to be from acute pancreatitis. He has a history of drinking at least a case of beer a day. He also smokes and appears cachectic. His old chart indicates a history of COPD, but he does not take medications for this. He does have a new productive cough. At change of shift, the nurse finds the patient dyspneic and slightly confused. Lung sounds have wheezes, and he is mildly febrile. Pulse is 120 beats/min, respirations are 32 breaths/min, and blood pressure is 118/64 mm Hg (baseline). Oximetry shows an SPO2 of 91%. 1. What risk factors for acute respiratory distress syndrome (ARDS) does this patient have?

Pancreatitis is a major risk factor for ARDS even when no other pulmonary disease is present. The widespread inflammatory response to pancreatitis can release so many inflammatory mediators that the mediators can reach lung tissue and cause damage. If the patient has been vomiting extensively with the pancreatitis, he may have aspirated some acidic vomitus into his lungs, causing further lung injury and triggering a local inflammatory response. This is more likely to occur with a person who drinks heavily and may actually lose his or her gag reflex to alcoholic stupor.

Parasympathetic nervous system serves as the heart's ______?

Parasympathetic nervous system serves as the heart's breaks. The vagus nerve carries impulses that slow the heart rate and the conduction of impulses through the AV node to the ventricles

4 Common Causes of Artifacts

Patient movement Loose or defective electrodes Improper grounding Faulty ECG apparatus

Supraglottic cancer

Patients with _______ ________ often present with symptoms like: 1. Sore throat 2. Painful/effortful swallowing 3. Referred ear pain 4. Change in voice quality 5. Hoarseness

ST Segment

Period between the completion of ventricular depolarization and beginning of ventricular repolarization

diastolic pressure

Period of relaxation and blood is drawn in the chamber

Manifestations of RHF

Peripheral Edema Hepatomegaly Ascites JVD

Peripheral bronchioles are _______ and _______ in number at birth.

Peripheral bronchioles are *narrow* and *fewer* in number at birth. (early on you don't have as much gas exchange because fewer alveoli("bundle of grapes-grapes are further apart"))

pusproducing infection occurring in the cavity at the back of the throat near tonsils.

Peritonsillar Abscess

quinsy infection secondary to

Peritonsillar Abscess

Inamrinone

Phosphodiesterase Inhibitor(inotrope and vasodilator)

Milrinone

Phosphodiesterase Inhibitor(inotrope and vasodilator)

Clopidogrel (Plavix)

Platelet Aggregation Inhibitor

Lead III

Positive (Left 5 th intercostal space mid clavicular line(apex); Negative (left 2nd intercostal space mid clavicular line)

Lead II

Positive (Left 5th intercostal space mid clavicular line(apex); Negative (Right 2nd intercostal space mic clavicular line).

Lead I

Positive (left 2nd intercostal space mid curricular line); Negative (Right 2nd intercostal space mic clavicular line).

MCL I (aka V1)

Positive (right 5th intercostal space just to the right of sternum) Negative (left 2nd intercostal space mid clavicular line)

Rhythmicity

Property of regularity of the intervals at which impulses are formed

Antidote for Heparin

Protamine sulfate

Calculate the pulse pressure of a patient whose blood pressure is 140/85 mm Hg after exercise. Fill in the blank using a whole number.

Pulse pressure is the difference between the systolic blood pressure and the diastolic blood pressure. 140 - 85 = 55. Test-Taking Tip: When taking the NCLEX exam, an on-screen calculator will be available for you to determine your response, which you will then type in the provided space. Text Reference - p. 690

The immune system attacks joint tissues of the host. The trigger is unknown. However, there are several risk factors Affects adults > 40 years Obesity increases risk of developing arthritis Family history of rheumatoid arthritis increases risk Cigarette smoking

RA

cessasion of Renin stops

RAAS System

Neurohormonal Compensatory Mechanism of HF

RAAS System to vasoconstrict and increased BP

cor pulmonale

RHF caused by pumonary dysfunction

Tx for spider bites/bleeding

RICE Rest ,Ice, Compression , Elevation

Ventricular Tachycardia (v-tach)

Rapid heart rate over 100 beats/min can be irregular or regular In most cases ventricular tachycardia is caused by heart disease, previous heart attack, congenital heart defect, hypertrophic or dilated cardiomyopathy, or myocarditis, post surgery, bleeding, dehydration

AV Node

Rate 40-60 BPM

SA Node

Rate 60-100 BPM

Major concern with fibrinolytic therapy is

Re occlusion of artery

all NPO client should get

Really good mouth care

Iggy Ch.32 p. 610, Patient-Centered Care; Safety; Evidence-Based Practice The patient is a 70-year-old retiree who had a hip replacement 2 days ago. His hip pain kept him from participating in his usual exercise program for the past 6 months. He is a former two-pack a day smoker. At home he decreased his fluid intake because ambulating to the bathroom was so painful. He resisted getting out of bed with physical therapy yesterday. When you assess him this morning, he reports nausea, some chest pain, mild shortness of breath, and anxiety. 1. What should be your first actions?

Reassure him that you will not leave him and that the right actions will be taken. Elevate the head of his bed to assist his respiratory efforts. Check his SpO2 for hypoxemia. Apply oxygen to improve gas exchange.

19. ____ hypertension can occur if hypertensive medications are suddenly stopped.

Rebound

The opening up of new channels through a blocked artery.

Recanalization

Nitric Oxide

Relaces arterial smooth muscle, resulting in vasodilation and decreased afterload

SNS Compensatory Mechanism of HF

Release of Catecholamines 1st and least effective: increases HR, contractility and causes peripheral vasoconstriction *Initiall helpful but then harmful

PR Interval

Represents atrial depolarization and delay through the A-V node Normal duration is 0.12- 0.20 second

ST Segment

Represents the end of ventricular conduction or depolarization and beginning of ventricular recovery or repolarization Normal ST segment: From the S wave to the beginning of the T wave

QT Interval

Represents ventricular depolarization and repolarization. A prolonged QT increases the risk of lethal arrhythmias and sudden cardiac death. Normal usually between 0.34 -0.43 seconds.

QRS Interval

Represents ventricular depolarization. Less than or equal to 0.12

T Wave

Represents ventricular repolarization (recovery phase) Normally upright in Lead II

CPR is done when

Resp or cardiac arrest

Respiratory causes of A-Fib include:

Respiratory causes of AF include pulmonary embolism, pneumonia and lung cancer

MC case and other common cause of type 1 hypersensitivity reaction that causes sore thoart

Smoking GERD

Atrial flutter risks:

Risks: Heart failure, heart attack, valve abnormalities or congenital defects, high blood pressure, recent surgery, thyroid dysfunction, alcoholism, chronic lung disease, acute (serious) illness, diabetes

epistaxis (nosebleed)

Rupture of nasal blood vessel causing blood to flow out nose into the throat

-caused when the closure of the mitral and tricuspid valves signals the beginning of the ventricular systole (contraction) and produces the sound -best heard with the diaphragm of the steth at the apex

S1

caused when the closure of the mitral and tricuspid valves signals the beginning of the ventricular systole (contraction) and produces the sound

S1

SA Node - _________ pacemaker with an intrinsic rate of ___ - ___ beats/minute.

SA Node - *Dominant pacemaker* with an intrinsic rate of *60 - 100* beats/minute.

path of electroconductivity of heart

SA node internodal pathway & interatrial pathway AV node Bundle of His Purkinje fibers

ECG changes with hypokalemia

ST depression shallow flat inverted T waves PROMINENET U waves ventricular dysrhythmias(PVSs especially) bradycardia enhanced Digitalis effect

T wave inversion = indicator of ischemic damage to myocardium. Typically, few changes to P waves occur during / after MI, whereas Q wave changes with no change in the

ST or T wave = old MI.

Textbook Case Studies 2. Two days later, subsequent testing has ruled out pulmonary embolism and coronary artery blockage, and the physician orders the infusion to be discontinued and oral amiodarone to be started. What does of oral amiodarone will the nurse expect to be ordered? Explain your answer.

Since A.F. has been on the amiodarone infusion for less than a week, the initial oral daily dose will be between 800 and 1600 mg/day for 1 to 3 weeks. The usual maintenance dose is 200 to 400 mg/day.

What method would you use to calculate HR for regular rhythm?

Small box(1500 divided by number of small squares or Big box (300 divided by the number of large squares in between Rs)

Aldosterone Antagonists

Spironolactone

Repolarization

Stage of the cardiac cycle is responsible for the refractory periods

Asystole

State of no cardiac electrical activity, hence no contractions of the myocardium and no cardiac output or blood flow.

Beta-adrenergic agonists

Stimulate the beta-receptors in the sympathetic nervous system, increasing calcium flow into the myocardial cells, and causing increased contraction

Supra ventricular tachycardia (SVT)

Supraventricular tachycardia refers to a *rapid, regular heart rhythm that begins in the atria* Many cases of SVT are *caused by the presence of a second pathway for electrical conduction*. In these cases, *electrical impulses* do not follow the normal conduction pathway, but rather *travel in "circles"* called reentry circuits. *The heart beats with each cycle, resulting in rapid heart rates typically between 150 and 250 beats per minute*

angioplasty

Surgical repair or re canalization of a blood vessel.

Pt teaching for Glycosides

Take radial pulse daily Do NOT take OTC meds check wt daily take as prescribed and do not swithc brands

Child (6-12yrs) vitals signs

Temp: 98.6F HR: 70-110 BP: 95/56 - 108/68 Resp: 18-30

Creatinine

Test of renal function *NPO 8 Hours* *List meds client is taking on lab slip *mg/dL* 0.3-0.6 (Infant) 0.4-1.2 (C) 0.7-1.4 (A)

The Frank-Starling law

The Frank-Starling law states that the stroke volume of the heart increases in response to an increase in the volume of blood filling the heart (the end diastolic volume) when all other factors remain constant. The increased volume of blood stretches the ventricular wall, causing cardiac muscle to contract more forcefully (A larger blood volume filling the ventricle at the end of diastole will cause the heart to contract more forcefully)

The nurse knows the ventricular contractions are directly stimulated by which anatomic feature of the heart?

The Purkinje fibers move the electrical impulse or action potential through the walls of both ventricles triggering synchronized right and left ventricular contraction. The sinoatrial (SA) node initiates the electrical impulse that results in atrial contraction. The atrioventricular (AV) node receives the electrical impulse through internodal pathways. The bundle of His receives the impulse from the AV node.

PAC Causes:

The cause of a premature heartbeat is generally unknown Can be caused by the following, caffeine, alcohol, stress, fatigue or poor sleep, medication that lists irregular heartbeat as a side effect

Pacemaker Modes The first letter of the code identifies.....

The first letter of the code identifies *the heart chamber being paced* V=ventricle A=atrium D=dual (ventricle and atrium) O= none

Lilley Ch.26 pg. Textbook Case Studies In the past 2 years, Mr. L., a 56-year-old architect, has experienced three episodes of deep vein thrombosis. All occurred without complications, and all were treated successfully with anticoagulant therapy and bed rest. He now arrives at the urgent care center because of increased pain and swelling in his left calf that has lasted for the past 3 days. On admission to the hospital for anticoagulant therapy, Mr.L. receives a bolus of 5000 units of heparin and is started on a continuous heparin infusion. 1. What nursing actions must be implemented to ensure the accuracy and safety of the continuous heparin infusion?

The following nursing actions may help to decrease some of the problems or adverse effects associated with anticoagulants: constantly monitoring all blood counts (RBCs, Hgb, Hct, platelets) and monitoring diagnostic laboratory reports that deal with clotting, such as activated partial thromboplastin time (aPTT) to monitor the heparin and prothrombin time-international normalized ratio (PT-INR) if the patient is started on warfarin later; monitoring liver and renal function studies; checking and rechecking dosage and route in the order from the physician; and using IV pumps for infusions. In many facilities, intravenous heparin doses are double-checked with another nurse. In addition to the correct dose and route, it is essential to use the correct strength of heparin as there are several different strengths available. Assess the patient for any problems with bleeding and ease in bruising. Assess urine, stools, and emesis for any evidence of blood. Assess the neurologic system and level of consciousness; the level of orientation, alertness, and ability to follow commands; and the motor strength and reflexes (upper and lower body).

Pacemaker Modes The fourth letter of the code describes the pacemakers.....?

The fourth letter of the code describes the pacemakers programmability; the letter tells whether an external programming device can modify the pacemaker P=programmable basic functions M=multiprogammable parameters C=communicating functions R=rate responsiveness O=none

Heart wall layers are?

The heart wall is made up of several layers Epicardium (outer layer) Pericardium (middle layer) Myocardium (muscle layer) Endocardium (inner layer)

pancreatic duct

The main duct of the pancreas. The pancreatic duct carries the exocrine secretions of the pancreas (enzymes and bicarbonate) to the small intestine (dueodenum).

Common cause of V-fib

The most common cause of VF is a heart attack. However, VF can occur whenever the heart muscle does not get enough oxygen for any reason

Lilley Ch.26 pg. 434-435 Textbook Critical Thinking and Prioritization Questions a. After a patient undergoes total hip replacement, the nurse reviews the new postoperative orders and notes an order for dalteparin (Fragmin) 2500 international units subcutaneously 6 hours after surgery, then 5000 international units daily for 7 days. When assessing the patient before administering the drug, the nurse sees that the patient has an epidural catheter for administration of pain medication. What is the nurse's priority action regarding the administration of the dalteparin?

The nurse must not give the anticoagulant. Dalteparin (Fragmin) and enoxaparin (Lovenox), both low-molecular-weight heparins (LMWHs), have black box warnings that specify that they are not to be given to a patient who has an indwelling epidural catheter because of the risk for an epidural hematoma. The LMWHs can be given 2 hours after the removal of an epidural catheter. Careful assessment is vital when administering anticoagulants.

Textbook Critical Thinking and Prioritization Questions 2. A patient has been admitted to the emergency department and is experiencing PSVT that has not responded to treatment with calcium channel blockers. Immediately after the patient receives a dose of adenosine (Adenocard) by intravenous push, the monitor shows asystole. What is the nurse's priority action in response to the asystole?

The nurse should remember that adenosine (Adenocard) may cause a transitory episode of asystole immediately after administration. The nurse should monitor the patient to make sure this asystole is indeed transitory and that either normal sinus rhythm or the PSVT returns. In addition, the nurse should make sure that the patient has a pulse when the heart rhythm reverts from asystole.

Lilley Ch.26 pg. Textbook Case Studies In the past 2 years, Mr. L., a 56-year-old architect, has experienced three episodes of deep vein thrombosis. All occurred without complications, and all were treated successfully with anticoagulant therapy and bed rest. He now arrives at the urgent care center because of increased pain and swelling in his left calf that has lasted for the past 3 days. On admission to the hospital for anticoagulant therapy, Mr.L. receives a bolus of 5000 units of heparin and is started on a continuous heparin infusion. During Mr. L.'s hospital stay, the physician orders an extra bolus of 10,000 units of heparin, IV push, because the results of Mr. L's laboratory tests indicate that his activated partial thromboplastin time (aPTT) is not at a therapeutic level. After giving the dose, the nurse notices that a dose of 50,000 units was given instead of 10,000 units. 3. What will the nurse do first, and what subsequent orders will the nurse prepare to carry out?

The patient has received an overdose of heparin—five times the ordered amount! The first action by the nurse would be to stop the heparin infusion. The nurse needs to stay with the patient and assess his vital signs as well as for any signs of unusual bleeding. Abdominal pain, back pain, bloody or tarry stools, bloody urine, constipation, blood in the sputum, severe or continuous headaches, and the vomiting of frank red blood or a coffee-ground substance (old blood) are all possible indications of internal bleeding. Observe also for decreased blood pressure accompanied by an increase in pulse rate and for changes in the level of consciousness. Another nurse needs to notify the patient's physician immediately. Fortunately, heparin has a very short half-life (1 to 2 hours). However, if excessive bleeding begins, the physician may order protamine sulfate as an antidote to the excessive heparin dose. This drug is a specific heparin antidote and forms a complex with heparin, completely reversing its anticoagulant properties. This occurs in as few as 5 minutes. In general, 1 mg of protamine can reverse the effects of 100 units of heparin.

Lilley Ch.26 pg. 434-435 Textbook Critical Thinking and Prioritization Questions 2. A patient is going home and will be taking warfarin (Coumadin). While discussing his medications just before his discharge to home, the patient says, "I want to get back to taking my vitamins with gingko. They really help my memory." What is the priority as the nurse answers the patient's question?

The priority is to ensure that the patient understands the interactions that may occur with warfarin. Certain herbal preparations, such as garlic, ginseng, and ginkgo, among others, may also cause a degree of anticoagulation. If the patient is already taking warfarin, the drug levels are carefully balanced to a particular degree of anticoagulation, which is monitored on a regular basis by prothrombin time/international normalized ratio (PT/INR) results. Adding another agent that also alters coagulation may increase the patient's risk for bleeding. The patient must avoid taking additional products, even over-the-counter products, that increase anticoagulation while taking warfarin.

Urokinase

Thrombolytic Agent

Pacemaker Modes The second letter of the code signifies

The second letter of the code signifies *the heart chamber in which the pacemaker sensed the intrinsic activity* V=ventricle A=atrium D=dual O= none

The sympathetic nervous system is the heart's ________?

The sympathetic nervous system is the heart's *accelerator*: norepinephrine and epinephrine increase heart rate, automaticity, atrioventricular conduction, and contractility

Pacemaker Modes The third letter shows the pacemaker's......?

The third letter shows the pacemaker's response to the intrinsic activity it senses in the atrium or ventricle T=triggers pacing (for instance, if atrial activity is sensed, ventricular pacing may be triggered) I=inhibits pacing (if the pacemaker senses intrinsic activity, it won't fire D=dual (the pacemaker can be triggered or inhibited depending on the mode and where intrinsic activity occurs O=none (the pacemaker doesn't change its mode in response to activity

Absolute refractory period

The time during the cardiac cycle in which the heart cannot respond to a stimulus (during depolarization)

Nonrefractory Period

The time when the heart is completely repolarized and ready to adequately and efficiently respond to another stimulus.

Second-degree blocks

There are two types of second-degree blocks, called Type 1 and Type 2. In both types, a P wave is blocked from initiating a QRS complex Type 1, there are increasing delays in each cycle before the omission Type 2, there is no such pattern

Three factors that affect stroke volume are?

Three factors affect stroke volume *Preload* *Afterload* *Myocardial contractility*

EKG Paper: Horizontal axis measures _____?

Time

Preform immediate cardioversion 50-100jules biphasic or 100jules monophasic Establish IV and give sedation If becomes pulseless defibrillate

Treatment for unstable tachycardia with pulse

33. Afterload is inversely related to stroke volume.

True

35. (True/False) The sputum of a patient with heart failure who develops pulmonary edema is described as pink and frothy.

True

43. (True/False) The primary pumping action facilitating return of venous blood to the heart is skeletal muscle contraction.

True

44. (True/False) Turbulent blood flow in a vessel creates a sound called a bruit.

True

Amioderone 150mg over 10 minutes Droneterone like aioderone but no iodine

Tx for tachycardia that is stable with narrow QRS that is not regular (possible Afib)

Unstable Angina (UA)

Unstable Angina (UA)

Tranexamic Acid

Used to tx excessive bleeding

Temporary Pacemaker

Usually inserted in an emergency; client showing s/s of decreased cardiac output (CO) with hypotension, and or syncope Serves as a bridge until an permanent pacemaker can be placed

What is referred to as auscultating the chest to evaluate how well voice sounds are transmitted?

Vocal Resonance

Antidote for Coumadin (Warfarin)

Vitamin K

Ask what 2 questions, when assessing respiratory?

What am I hearing ??? What should I expect to hear??? (Is it as simple as a reassessment?-reassess sooner than 4 hrs!) (Is there need for interventions?)

Stable angina

What form of angina is characterized by • Coronary artery luminal narrowing, symptom occurrence during exertion, ST segment depression on ECG?

When ausculating the lungs you want to listen _________ and _________.

When ausculating the lungs you want to listen *anteriorly(front) and posteriorly(back).*

Tail of Spence

Where 48% of breast tumors occur upper outer quadrant (under axilla)

Iggy Study Guide Ch.31 63. The nurse is teaching a patient about the combination drug therapy that is used in the gtreatment of TB. Which patient statement indicates the nurse's instruction was effective? a. "I will take three drugs: isoniazid, rifampin, and pyrazinamide, then ethambutol may be added later." b. "Combining the drugs in one pill is a convenient way for me to take all the medications." c. "The isoniazid combines with the TB bacteria. I can take the rifampin and pyrazinamide if I continue to have symptoms." d. "Combining the mdications means to take the isoniazid, rifampin, and pyrazinamide all at the same time."

a

Iggy Study Guide Ch.32 25. A patient demonstrates chest pain, dyspnea, dry cough, and change in level of consciousness. The nurse suspects PE and notifies the health care provider who orders an arterial blood gas (ABG). In the early stage of a PE, what would ABG results probably indicate? a. Respiratory alkalosis b. Respiratory acidosis c. Metabolic acidosis d. Metabolic alkalosis

a

Respiratory problems may result from what 2 problems?

structural problems, functional problems or a combination

1. How does morphine relieve chest pain in the patient with an acute MI? a. widens the diameter of the arteries of the heart b. Thins the blood where the blockage is located c. Increases the heart rate and blood pressure d. Narrows the blood vessel diameter.

a

16. The nurse administers sublingual nitroglycerine to a patient experiencing an angina episode. How soon does the nurse expect the pain to begin to subside? a. 1-2 minutes b. 5-6 minutes c. 10-12 minutes d. 15-20 minutes

a

19. Which patient has the highest risk for death because of ventricular failure and dysrhythmias related to damage to the left ventricle? a. Patient with an anterior wall MI (AWMI) b. Patient with a posterior wall MI (PWMI) c. Patient with a lateral wall MI (LWMI) d. Patient with an infferior wall MI (IWMI)

a

20. A patient had an IWMI. The nurse closely monitors the patient for which dysrhythmia associated with IWMI? a. Bradycardia and second-degree heart block b. Premature ventricular contractions c. supraventricular tachycardia d. Atrial fibrillation

a

28. The emergency department (ED) nurse is assessing an 86-year-old patient with acute confusion, increased respiratory rate, anxiety, and chest pain. The nurse finds a respiratory rate of 36/min with crackles and wheezes on auscultation. How does the nurse interpret these findings? a. Left ventricular heart failure b. Atypical angina c. CAD d. Unstable angina

a

7. A patient is hypertensive and continues to have angina despite therapy with beta blockers. The nurse anticipates which type of drug will be prescribed for this patient? a. Calcium channel blocker b. digoxin c. Angiotensin-converting enzyme (ACE) d. Dopamine

a

9. A patient is admitted for unstable angina. The patient is currently asymptomatic and all vital signs are stable. Which position does the nurse place the patient in? a. Any position of comfort b. Supine c. Sitting in a chair d. Fowler's

a

A patient with chronic heart failure who is taking digoxin (Lanoxin) 0.25 mg PO daily with furosemide (Lasix) 60 mg PO daily develops nausea and vomiting. The home care nurse should a. notify the health care provider. b. perform a dipstick urine test for protein. c. instruct the patient to increase intake of high-potassium foods. d. ask the patient to weigh each morning and call the nurse in 3 days.

a

Iggy Study Guide Ch.31 12. A child is diagnosed with a group B streptococcus throat infection. In teaching the patents about treatment of the infection, what does the nurse instruct the parents? a. Need to complete entire course of penicillin or penicillin-like antibiotics b. Gradual return to activities until there are no physical complaints c. Purpose of a clear liquid diet until infection subsides d. Signs and symptoms of meningitis, which is a common complication

a

Iggy Study Guide Ch.31 57. Which test result indicates a patient has clinically active TB? a. Induration of 12 mm and positive sputum b. Positive chest x-ray for TB c. Positive chest x-ray and clinical symptoms d. Sputum tests positive for blood

a

The nurse cares for the client receiving IV steroids. The nurse should observe for which finding? CORRECT A. Weight gain and mood swings. B. Confusion and psychosis. C. Hyperkalemia and hyponatremia. WRONG D. Osteoporosis and gastric ulcers.

a

Rudd Ch.12 Pg.246-247 Review Questions 9. In assessing a heart murmur in an infant with a patent ductus arteriosus (PDA), the nurse is most likely to note a a. "washing machine" murmur b. harsh clicking sound c. soft, squeaking murmur d. gallop murmur

a "washing machine" murmur

Question 16 of 24 Which client has the highest risk for developing a pulmonary embolism (PE)? a. A 25-year-old woman who frequently flies to different countries b. A 67-year-old man who works on a farm c. A 45-year-old man admitted for a heart attack d. A 23-year-old woman with a bleeding disorder

a A 25-year-old woman who frequently flies to different countries People who engage in prolonged and frequent air travel are at higher risk for PE. A 67-year-old man who works on a farm is not at high risk because he has an active lifestyle. A heart attack is usually caused by a thrombus or occlusion of the coronary arteries, not of the legs; if on prolonged bedrest, the client's risk is increased. PE is a clotting disorder, not a bleeding disorder.

1. A client with unstable angina has received education about acute coronary syndrome. Which statement indicates that the client has understood the teaching? a. "This is a big warning; I must modify my lifestyle or risk having a heart attack in the next year." b. "Angina is just a temporary interruption of blood flow to my heart." c. "I need to tell my wife I've had a heart attack." d. "Because this was temporary, I will not need to take any medications for my heart."

a Among people who have unstable angina, 10% to 30% have a myocardial infarction within 1 year. Although anginal pain is temporary, it reflects underlying coronary artery disease (CAD), which requires attention, including lifestyle modifications. Unstable angina reflects tissue ischemia, but infarction represents tissue necrosis. Clients with underlying CAD may need medications such as aspirin, lipid-lowering agents, anti-anginals, or antihypertensives.

Question 24 of 24 The medical-surgical unit nurse should call the Rapid Response Team to assess which client? a. Client with a diagnosed pulmonary embolism who is receiving IV heparin and has bright-red hemoptysis b. Client with deep vein thrombosis who is receiving low-molecular-weight heparin and has ongoing calf pain c. Client with a right pneumothorax who is being treated with a chest tube and has a pulse oximetry of 94% d. Client who was extubated 3 days ago and has decreased breath sounds at the posterior bases of both lungs

a Client with a diagnosed pulmonary embolism who is receiving IV heparin and has bright-red hemoptysis The client with a diagnosed pulmonary embolism is showing signs of possible pulmonary infarction or bleeding abnormality secondary to heparin; this indicates a significant decline in status and warrants activation of the Rapid Response Team. The client with deep vein thrombosis requires ongoing monitoring and is receiving appropriate treatment; calf pain is expected in this situation. The client with a right pneumothorax requires ongoing monitoring but has normal oxygen saturation. The client who was extubated 3 days ago requires ongoing monitoring or nursing intervention, but does not have evidence of acute deterioration or severe complications.

Lilley Ch 26 NCLEX® Examination Questions 5. Which medication is an antiplatelet drug? a. Clopidogrel (Plavix) b. Alteplase (Activase) c. Heparin (Hemochron) d. Enoxaparin (Lovenox)

a Clopidogrel (Plavix) is an antiplatelet drug. Enoxaparin and heparin are anticoagulants. Alteplase is a thrombolytic drug.

Evolve 7. The patient is prescribed ibutilide (Corvert), a class III antiarrhythmic drug. The nurse understands this drug has been prescribed for which reason? a. Conversion of recent-onset atrial fibrillation and flutter b. Treatment of PSVT c. Conversion of life-threatening ventricular dysrhythmias d. Treatment of dysrhythmias in patients with acute renal failure

a Conversion of recent-onset atrial fibrillation and flutter Ibutilide is specifically indicated only for treatment of recent-onset atrial fibrillation and flutter.

Question 6 of 24 Wich intervention for a client in the intensive care unit (ICU) will decrease the incidence of "ICU psychosis?" a. Decreasing nighttime disruptions b. Keeping the lights on to promote orientation c. Administering sedation d. Providing television or radio for stimulation

a Decreasing nighttime disruptions ICU psychosis can be minimized not only by encouraging sleep, but also by keeping to a regular routine. Keeping the lights on or providing TV or radio will not encourage sleep. Sedation can promote confusion and disorientation.

19. After receiving change-of-shift report in the coronary care unit, which client does the nurse assess first? a. The client with acute coronary syndrome who has a 3-pound weight gain and dyspnea b. The client with percutaneous coronary angioplasty who has a dose of heparin scheduled c. The client who had bradycardia after a myocardial infarction and now has a paced heart rate of 64 beats/min d. A client who has first-degree heart block, rate 68 beats/min, after having an inferior myocardial infarction

a Dyspnea and weight gain are symptoms of left ventricular failure and pulmonary edema; this client needs prompt intervention. A scheduled heparin dose does not take priority over dyspnea; it can be administered after the client with dyspnea is taken care of. The client with a pacemaker and a normal heart rate is not in danger. First-degree heart block is rarely symptomatic, and the client has a normal heart rate; the client with dyspnea should be seen first.

Lilley Ch 26 NCLEX® Examination Questions 3 The nurse notes a patient's international normalized ratio (INR) value of 2.5. What is the meaning of this reported value? a. The patient's warfarin dose is within the therapeutic range. b. The patient needs the subcutaneous heparin dose increased. c. The patient is not receiving enough warfarin for a therapeutic effect. d. The patient is receiving too much heparin and is at risk for bleeding.

a INR determination is a routine test to evaluate coagulation while patients are taking warfarin, not heparin. A therapeutic INR is 2 to 3.

Question 12 of 24 All of these nursing actions are included in the plan of care for a client who has just been extubated. Which action should the nurse delegate to unlicensed assistive personnel (UAP)? a. Keep the head of the bed elevated. b. Teach about incentive spirometer use. c. Monitor vital signs every 5 minutes. d. Adjust the nasal oxygen flow rate.

a Keep the head of the bed elevated. Positioning of clients is included in UAP education and scope of practice and can be delegated. Client teaching is an activity performed by the professional nurse. Although taking vital signs is an activity of the UAP, monitoring a potentially unstable client is done by the professional nurse. Adjusting oxygen flow rates requires complex decision making and should be done by the RN.

Iggy Study Guide Ch.32 3. What is the most common cause of embolism? a. Amniotic fluid b. Air bolus c. Blood clot d. Arterial plaque

c

Lilley Ch 26 NCLEX® Examination Questions 10. A patient who is prescribed an anticoagulant requests an aspirin (acetylsalicylic acid) for headache relief. What is the nurse's best action? a. Inform the patient of potential drug interactions with anticoagulants. b. Explain that a common initial adverse effect is a headache for this drug. c. Explain that acetylsalicylic acid is contraindicated and administer ibuprofen. d. Administer 650 mg of acetylsalicylic acid and reassess pain in 30 minutes.

a Patients taking an anticoagulant should not use medications that would further increase the risk of bleeding.

Question 9 of 24 Which intervention will be most effective in reducing anxiety in a client with a pulmonary embolism (PE)? a. Remain with the client and provide oxygen in a calm manner. b. Have the client breathe into a brown paper bag using pursed lips. c. Offer the client a mild sedative. d. Allow a family member to remain in the room.

a Remain with the client and provide oxygen in a calm manner. The underlying cause for anxiety with a PE is hypoxemia, which will be alleviated by oxygen; remaining with the client in distress is appropriate. Rebreathing from a brown paper bag is an intervention that increases PaCO2 during hyperventilation, as in a panic attack; it will not provide needed oxygen. Sedation and/or allowing a family member to stay may calm the client, but will not improve oxygenation.

Evolve 2. A patient is receiving lidocaine (Xylocaine) by continuous intravenous (IV) infusion. The nurse understands this medication is prescribed for what condition? a. Ventricular dysrhythmias b. Sinus bradycardia c. Atrial fibrillation d. First-degree heart block

a Ventricular dysrhythmias Lidocaine is a sodium channel blocker drug used specifically to treat ventricular dysrhythmias.

Rudd Ch.12 Pg.246-247 Review Questions 5. The caregiver caring for a child following a cardiac catheterization should monitor a. heart rate and rhythm b. color of hands and feet c. excessive salivation d. respiratory depression

a heart rate and rhythm

A patient with chronic HF and atrial fibrillation is treated with a digitalis glycoside and a loop diuretic. To prevent possible complications of this combination of drugs, what does the nurse need to do (select all that apply)? a. Monitor serum potassium levels b. teach the patient how to take a pulse rate. c. keep an accurate measure of intake and output d. Teach the patient about dietary restriction or potassium e. Withhold digitalis and notify health care provider if heart rate is irregular

a & b Rationale: Hypokalemia, which can be caused by the use of potassium-depleting diuretics (e.g., thiazides, loop diuretics), is one of the most common causes of digitalis toxicity. Low serum levels of potassium enhance the action of digitalis, causing a therapeutic dose to achieve toxic levels. Hypokalemia can also precipitate dysrhythmias. Monitoring the serum potassium levels of patients receiving digitalis preparations and potassium-depleting diuretics is essential. Patients taking digitalis preparations should be taught how to measure their pulse rate because bradycardia and atrioventricular blocks are late signs of digitalis toxicity. In addition, patients should know what pulse rate would necessitate a call to the health care provider.

Automaticity is defined as?

a cell's ability to spontaneously initiate an impulse Pacemaker cells possess this ability

peripheral vascular disease (PVD)

a condition in which the legs, feet, arms, or hands do not have enough blood circulation

CPB and CABG

cardiopulmonary bypass graft and coronary artery bypass graft

dipole

a separation of electrically charged regions; average direction of cells electrical activity goes down toward apex of heart

stent

a small piece of tubing placed in an artery to help keep it open after an angioplasty has been done

Beginning warfarin concomitantly with heparin can provide a stable INR by which day of heparin treatment? a) 5 b) 2 c) 3 d) 4

a) 5 Explanation: Beginning warfarin concomitantly with heparin can provide a stable INR by day 5 of heparin treatment, at which time the heparin maybe discontinued.

When caring for a client with a diagnosis of aortic aneurysm scheduled for surgery, what would be most important for the nurse to monitor? a) Level of consciousness, characteristics of pain, and signs of hemorrhage or dissection b) Intake and output, nutrition level, respirations, and characteristics of pain c) Cultural needs, characteristics of pain, and signs of hemorrhage or dissection d) BP, pulse, respirations, and signs of hemorrhage or dissection

a) Level of consciousness, characteristics of pain, and signs of hemorrhage or dissection Explanation: The nurse monitors BP, pulse, hourly urine output, skin color, level of consciousness, and characteristics of pain for signs of hemorrhage or dissection. Assessing respirations, nutritional levels, and cultural needs are important but not the most important assessments for the nurse to make.

Which of the following is accurate regarding the effects of nicotine and tobacco smoke on the body? Select all that apply. a) Reduces circulation to the extremities b) Impairs transport and cellular use of oxygen c) Causes vasospasm d) Increases blood viscosity e) Decreases blood viscosity

a) Reduces circulation to the extremities b) Impairs transport and cellular use of oxygen c) Causes vasospasm d) Increases blood viscosity Explanation: Nicotine from tobacco products causes vasospasm and can dramatically reduce circulation to the extremities. Tobacco smoke also impairs transport and cellular use of oxygen and increases blood viscosity.

A nurse should be prepared to manage complications following abdominal aortic aneurysm resection. Which complication is most common? a) Renal failure b) Graft occlusion c) Hemorrhage and shock d) Enteric fistula

a) Renal failure Explanation: Renal failure commonly occurs if clamping time is prolonged, cutting off the blood supply to the kidneys. Hemorrhage and shock are the most common complications before abdominal aortic aneurysm resection, and they occur if the aneurysm leaks or ruptures. Graft occlusion and enteric fistula formation are rare complications of abdominal aortic aneurysm repair.

A client has a blockage in the proximal portion of a coronary artery. After learning about treatment options, the client decides to undergo percutaneous transluminal coronary angioplasty (PTCA). During this procedure, the nurse expects to administer an: a) anticonvulsant. b) antihypertensive. c) anticoagulant. d) antibiotic.

a) anticoagulant. Explanation: During PTCA, the client receives heparin, an anticoagulant, as well as calcium agonists, nitrates, or both, to reduce coronary artery spasm. Nurses don't routinely give antibiotics during this procedure; however, because the procedure is invasive, the client may receive prophylactic antibiotics to reduce the risk of infection. An antihypertensive may cause hypotension, which should be avoided during the procedure. An anticonvulsant isn't indicated because this procedure doesn't increase the risk of seizures.

When caring for a client with a diagnosis of aortic aneurysm scheduled for surgery, what would be most important for the nurse to monitor? a) Level of consciousness, characteristics of pain, and signs of hemorrhage or dissection b) BP, pulse, respirations, and signs of hemorrhage or dissection c) Cultural needs, characteristics of pain, and signs of hemorrhage or dissection d) Intake and output, nutrition level, respirations, and characteristics of pain

a)Level of consciousness, characteristics of pain, and signs of hemorrhage or dissection Explanation: The nurse monitors BP, pulse, hourly urine output, skin color, level of consciousness, and characteristics of pain for signs of hemorrhage or dissection. Assessing respirations, nutritional levels, and cultural needs are important but not the most important assessments for the nurse to make.

Question 11 of 24 The nurse is caring for a group of clients. Which clients should be monitored closely for respiratory failure? Select all that apply. a. Client with a brainstem tumor b. Client with acute pancreatitis c. Client with a T3 spinal cord injury d. Client using patient-controlled analgesia e. Client experiencing cocaine intoxication

a, b, c, d, Client with a brainstem tumor, Client with acute pancreatitis, Client with a T3 spinal cord injury, Client using patient-controlled analgesia Pressure on the brainstem may depress respiratory function. Acute pancreatitis is a risk factor for acute respiratory distress syndrome; abdominal distention also ensues, which can limit respiratory excursion. Clients with cervical and thoracic spinal cord injuries are at high risk for respiratory failure because spinal nerves that affect intercostal muscles are affected. Opiates, which can depress the brainstem, present risk factors for respiratory failure. All of these clients should be monitored closely for respiratory failure. Cocaine is a stimulant, which would not cause respiratory failure unless a stroke ensued.

A patient admitted with heart failure appears very anxious and complains of shortness of breath. Which nursing actions would be appropriate to alleviate this patient's anxiety (select all that apply)? a. Administer ordered morphine sulfate. b. Position patient in a semi-Fowler's position. c. Position patient on left side with head of bed flat. d. Instruct patient on the use of relaxation techniques. e. Use a calm, reassuring approach while talking to patient.

a, b, d, & e Morphine sulfate reduces anxiety and may assist in reducing dyspnea. The patient should be positioned in semi-Fowler's position to improve ventilation that will reduce anxiety. Relaxation techniques and a calm reassuring approach will also serve to reduce anxiety.

24. When planning care for a client in the emergency department, which interventions are needed in the acute phase of myocardial infarction? (Select all that apply.) a. Morphine sulfate b. Oxygen c. Nitroglycerin d. Naloxone e. Acetaminophen f. Verapamil (Calan, Isoptin)

a,b,c Morphine is needed to reduce oxygen demand, preload, pain, and anxiety, and nitroglycerin is used to reduce preload and chest pain. Administering oxygen will increase available oxygen for the ischemic myocardium. Naloxone is a narcotic antagonist that is used for overdosage of opiates, not for MI. Acetaminophen may be used for headache related to nitroglycerin. Because of negative inotropic action, calcium channel blockers such as verapamil are used for angina, not for MI.

34. The ED nurse, caring for a patient with severe chest pain and ECG changes, gives supplemental oxygen to the patient as ordered. Which other medications does the nurse anticipate giving to this patient? (Select all that apply.) a. IV nitroglycerin b. Beta blocker c. IV morphine d. Oral aspirin e. ACE inhibitor

a,b,c,d

Evolve 12. For patients prescribed amiodarone (Cordarone), the nurse should monitor for which potential adverse effects of this drug? (Select all that apply.) a. Hypothyroidism b. Visual halos c. Photosensitivity d. Blue gray skin discoloration e. Overgrowth of gum tissue f. Diarrhea

a,b,c,d Hypothyroidism, Visual halos, Photosensitivity, Blue gray skinndiscoloration Potential adverse effects from amiodarone include visual halos, photosensitivity, photophobia, dry eyes, bluish skin discoloration, hyperthyroidism, hypothyroidism, co

Lilley Ch 26 NCLEX® Examination Questions 14. The nurse recognizes that the patient understands the teaching about warfarin (Coumadin) when the patient verbalizes an increased risk of bleeding with concurrent use of which herbal product? (Select all that apply.) a. Garlic b. Ginkgo c. Dong quai d. Glucosamine e. St. John's wort

a,b,c,e Garlic, ginkgo, dong quai, and St. John's wort alter blood coagulation and may increase the risk of bleeding when given concurrently with oral anticoagulants. Glucosamine does not affect coagulation.

26. A patient reports having chest discomfort that started during exercise. The patient is currently pain-free, but is "concerned." What questions must the nurse ask to assess the patient's pain episode? (Select all that apply.) a. "When did the pain start and how long did it last?" b. "What were you doing when the pain started?" c. "What did you do alleviate the pain?" d. "How did you feel about the pain?" e. "Did the pain radiate to other locations?" f. "On a scale of 0 to 10 with 10 as the worst pain, what number would you use to categorize the pain?"

a,b,c,e,f

38. A patient is newly diagnosed with cardiovascular disease. What psychosocial reactions does the nurse assess for? (Select all that apply.) a. Fear b. Anxiety c. Anger d. Suspicion e. Denial f. Depression

a,b,c,e,f

Iggy Study Guide Ch.32 7. The nurse is caring for several postoperative patients at risk for developing PE. Which interventions does the nurse use to help prevent the development of PE in these patients? (Select all that apply.) a. Start passive and active range-of-motion exercises for the extremities. b. Ambulate postoperative patients soon after surgery. c. Use antiembolism devices postoperatively. d. Elevate legs in an extended position. e. Change patient position every 4 to 6 hours. f. Administer drugs to prevent episodes of Valsalva maneuver.

a,b,c,f

40. Which statements are true about the use of thrombolytic agents for a patient with an acute MI? (Select all that apply.) a. A patient who has received a thrombolytic agent must be continuously monitored before and after the medication is given. b. Thrombolytic therapy is indicated for chest pain of longer than 30 minutes duration that is unrelieved by other medications. c. There are no contraindications to thrombolytic therapy if the patient is having an acute MI as evidenced by cardiac enzymes and ECG. d. Bleeding is a risk for patients receiving thrombolytic therapy. e. The nurse need only monitor clotting studies of the patient who has received thrombolytic therapy. No further assessment is needed.

a,b,d

Iggy Study Guide Ch.31 65. The patient is receiving isoniazid (INH) to treat TB. Which nursing teaching points are essential when giving this drug? (Select all that apply.) a. Teach the patient not to take medications such as Maalox with this medication. b. Avoid drinking alcoholic beverages. c. Teach the patient that urine will be orange in color. d. Take a multivitamin with B complex. e. If going out in the sun, be sure to wear protective clothing and sunscreen. f. Teach women that this drug reduces the effectiveness of oral contraceptives.

a,b,d

22. The nurse is preparing to teach a client that metabolic syndrome can increase the risk for myocardial infarction (MI). Which signs of metabolic syndrome should the nurse include in the discussion? (Select all that apply.) a. Truncal obesity b. Hypercholesterolemia c. Elevated homocysteine levels d. Glucose intolerance e. Client taking losartan (Cozaar)

a,b,d,e A large waist size (excessive abdominal fat causing central obesity)—40 inches (102 cm) or greater for men, 35 inches (88 cm) or greater for women—is a sign of metabolic syndrome. Decreased high-density lipoprotein cholesterol (HDL-C) (usually with high low-density lipoprotein cholesterol)—HDL-C less than 40 mg/dL for men or less than 50 mg/dL for women—or taking an anticholesterol drug is a sign of metabolic syndrome. Increased fasting blood glucose (caused by diabetes, glucose intolerance, or insulin resistance) is included in the constellation of metabolic syndrome. Blood pressure greater than 130/85 mm Hg or taking antihypertensive medication indicates metabolic syndrome. Although elevated homocysteine levels may predispose to atherosclerosis, they are not part of metabolic syndrome.

44. A patient has received thrombolytic therapy for treatment of acute MI. What are postadministration nursing responsibilities for this treatment? (Select all that apply.) a. Document the patient's neurologic status. b. Observe all IV sites for bleeding and patency. c. Monitor white blood cell (WBC) count and differential. d. Monitor clotting studies. e. Monitor hemoglobin and hematocrit. f. Test stools, urine, and emesis for occult blood.

a,b,d,e,f

12. A patient is admitted for acute MI, but the nurse notes that the traditional manifestation of ST-elevation myocardial infarction (STEMI) is not occurring. What other evidence for acute MI does the nurse expect to find in the patient? (Select all that apply.) a. Positive troponin markers b. Chronic stable angina c. Non-ST elevation IM (non-STEMI) on ECG d. Cardiac dysrhythmia e. Heart failure

a,c

Iggy Study Guide Ch.31 56. After several weeks of "not feeling well", a patient is seen in the provider's office for possible TB. If TB is present, which assessment findings does the nurse expect to observe? (Select all that apply.) a. Fatigue b. Weight gain c. Night sweats d. Chest soarneness e. Low-grade fever

a,c,e

Iggy Study Guide Ch.32 1. Which are the risk factors for pulmonary embolism (PE) and deep vein thrombosis (DVT)? (Select all that apply.) a. Trauma b. Swimming activity c. Heart failure d. Chronic obstructive pulmonary disease (COPD) e. Cancer (particularly lung or prostate)

a,c,e

Lilley Ch 26 NCLEX® Examination Questions 15. For a patient receiving an IV infusion of alteplase (Activase), which nursing actions should be taken? (Select all that apply.) a. Assess for cardiac dysrhythmias. b. Administer injections intramuscularly. c. Record vital signs and report changes. d. Monitor for an increase in liver enzymes. e. Observe for signs and symptoms of bleeding.

a,c,e Alteplase can cause bleeding as well as cardiac dysrhythmias. Vital sign changes can alert the nurse to these complications. Alteplase does not directly affect liver enzymes. Injections should not be administered intramuscularly because of the increased risk of bleeding.

42. A patient is being evaluated for thrombolytic therapy. What are absolute contraindications for this procedure? (Select all that apply.) a. Ischemic stroke within 3 months b. Pregnancy c. Suspected aortic aneurysm d. Major trauma in the last 12 months e. Intracranial hemorrhage f. Malignant intracranial neoplasm

a,c,e,f

Iggy Study Guide Ch.32 14. The nurse is caring for a patient with a post-operative complication of PE. The patient has been receiving treatment for several days. Which factors are indicators of adequate perfusion in the patient? (Select all that apply.) a. Pulse oximetry of 95% b. Arterial blood gas, pH of 7.28 c. Patient's subjective desire to ho home d. Absence of pallor or cyanosis e. Mental status at patient's basline

a,d,e

10. Which are characteristics of angina? (Select all that apply.) a. Pain is precipitated by exertion or stress. b. Pain occurs without cause, usually in the morning. c. Pain is relieved only by opioids. d. Pain is relieved by nitroglycerin or rest. e. Nausea, diaphoresis, feelings of fear, and dyspnea may occur. f. Pain lasts less than 15 minutes.

a,d,f

1. The nurse is interviewing a patient reporting chest discomfort that occurs with moderate to prolonged exertion. The patient describes the pain as being "about the same over the past several months and going away with nintroglycerin or rest." Based on the patient's description of symptoms, what does the nurse suspect in this patient? (Select all that apply.) a. chronic stable angina (CSA) b. Unstable angina c. Acute coronary sndrome (ACS) d. Acute myocardial infraction (MI) e. Coronary artery disease (CAD)

a,e

Student Question Banks - Rudd Ch.12 9. The nurse is caring for a premature infant with a patent ductus arteriosus. What assessment finding would support this diagnosis? a. Enlargement of the liver due to venous congestion b. Pulmonary congestion due to reduced right ventricular output c. Reduced oxygen saturation due to insufficient blood to the lungs d. Reduced capillary refill due to inadequate peripheral circulation

a. A patent ductus arteriosus would not cause venous congestion. b. A patent ductus arteriosus reduces blood flow to the lungs and would not cause pulmonary congestion c. CORRECT - Oxygen saturation is compromised by reduced blood flow to the lungs, reducing oxygenation of the blood. d. Peripheral circulation is not compromised by a patent ductus arteriosus.

A patient has a severe blockage in his right coronary artery. Which cardiac structure is most likely to be affected by this? a. AV node b. left ventricle c. Coronary Sinus d. Pulmonary Valve

a. AV node Rationale: The right coronary artery (RCA) supplies blood to the right atrium, the right ventricle, and a portion of the posterior wall of the left ventricle. In 90% of people, the RCA supplies blood to the atrioventricular (AV) node, the bundle of His, and part of the cardiac conduction system.

Student Question Banks - Rudd Ch.12 4. The nurse is planning care for a child admitted with a diagnosis of coarctation of the aort (COA). What is an important intervention for the nurse to include in this child's plan of care? a. Monitor four extremity vital signs b. Administer supplemental oxygen c. Maintain continuous prostaglandin E infusion d. Provide frequent sedation to prevent crying

a. CORRECT - Coarctation of the aorta is often first diagnosed by noted differences in blood pressure in all four extremities, so monitoring four extremity vital signs will act as a means of evaluating the patient. b. Supplemental oxygen is usually not required. c. Prostaglandin E is not administered to a child with a coarctation of the aorta. d. Frequent sedation is needed for children with Tetralogy of Fallot, not coarctation of the aorta.

Student Question Banks - Rudd Ch.12 15. The nurse is caring for an adolescent admitted with dilated cardiomyopathy. What medications will the nurse anticipate administering to this child? Select all that apply. a. Digoxin b. Diuretic c. Anticoagulant d. ACE inhibitors e. Analgesics

a. CORRECT - Digoxin is administered to improve the pumping effort of the heart. b. CORRECT - Heart failure often results, requiring diuretics to prevent or reduce fluid volume excess. c. CORRECT - Anticoagulants may be administered to prevent blood clots caused by slow blood flow. d. ACE inhibitors are more likely to be given to those with restrictive cardiomyopathy to relax the coronary arteries. e. Pain is not an anticipated symptom with dilated cardiomyopathy, so analgesics are not usually required.

Student Question Banks - Rudd Ch.12 1. The nurse is caring for a child diagnosed with a cardiac problem. What is the highest priority nursing assessment? a. Oxygenation b. Heart sounds c. Urinary output d. Neurological function

a. CORRECT - If you apply the ABC's, maintaining oxygenation is the highest priority. b. While heart sounds should be auscultated, this is not the first priority. c. Urinary output can be a good indication of fluid volume and perfusion but is not the first pirority. d. Neurological function should be monitored to assess perfusion, but it is not the first priority.

Student Question Banks - Rudd Ch.12 8. The nurse admits an 8-year-old from the ED diagnosed with rheumatic heart disease. What priority nursing history question should the nurse ask? a. "Did your child have a sore throat approximately 3 weeks ago?" b. "What is your socioeconomic status?" c. "When did your child last attend school?" d. "Does your child have ADHD?"

a. CORRECT - Rheumatic heart disease can be the result of an untreated strep throat, so this would be an appropriate question to ask. b. This question has no meaning in relationship to rheumatic heart disease. c. This question does not add to the nurse's ability to plan care for this child. d. ADHD is not associated with rheumatic heart disease.

Student Question Banks - Rudd Ch.12 5. The nurse is caring for a patient with supraventricular aortic stenosis, pulmonary artery stenosis, a small upturned nose, long philtrum, wide mouth, and a small chin. What syndrome does the nurse suspect? a. Wiliams b. Noonan c. Down d. Marfan

a. CORRECT - This description matches Williams syndrome. b. Children with Noonan syndrome generally have pulmonic valve stenosis, left ventricular hypetrophy, elfin faces, and pectus deformity among other things. c. Children with Down syndrome generally present with AV canal, ventricular septal defects, developmental delay, low-set ears, and large tongue among other features. d. Children with Marfan syndrome generally present with an aortic aneurism, aortic and/or mitral regurgitation, disporportionately long arms, dislocation of lenses, and spinal problems among other features.

Student Question Banks - Rudd Ch.12 10. The nurse is caring for a baby born with a hypoplastic left heart. The student nurse asks about the baby's prognosis. What is the nurse's most accurate response? a. The baby will need immediate surgery, but long-term survival is unlikely without a heart transplant. b. If the baby survives the first surgery, there is a good chance the baby will have a normal life span. c. The baby will require a three-stage Norwood but then will most likely survive with severe intolerance during mobility. d. The baby will need to regularly follow up with the cardiologist, but otherwise he will live a relatively normal life.

a. CORRECT - This is an accurate description of the baby's prognosis. b. Even if the baby survives the first surgery, the likelihood for a normal life span is unrealistic. c. Most children with a hypoplastic left heart will require a heat transplant shortly after birth, so this statement is misleading. d. While the child will need to be closely followed if it survives, a relatively normal life is unrealistic.

Which nursing responsibilities are priorities when caring for patient returning from a cardiac catherization (select all that apply)? a. Monitoring vital signs and ECG b. Checking the catheter insertion site and distal pulses c. assisting the patient to ambulate to the bathroom to void d. informing the patient that he will be sleepy from the general anesthesia e. instructing the patient about the risks of the radioactive isotope injection.

a. Monitoring vital signs and ECG b. Checking the catheter insertion site and distal pulses

Student Question Banks - Rudd Ch.12 13. The mother of a newborn with transposition of the great vessels asks the nurse the purpose of administering prostaglandin E. What is the nurse's best response to explain the rationale for administering this drug? a. It increases oxygenation of the blood and makes the left ventricle pump more effectively. b. It maintains an open ductus arteriosus to allow mixing of oxygenated and unoxygenated blood. c. It sedates the baby so he won't cry and become more cyanotic. You'll learn to give it to him. d. It repairs the baby's damaged heart so circulates normally as long as the drug infuses.

a. Prostaglandin E does not increases Oxygenation. b. CORRECT - Prostaglandin E causes a patent ductus arteriosus, which allows for mixing of oxygenated and unoxygenated blood: this is required to oxygenate the blood of a child with transposition of the great vessels. c. Prostaglandin E is not a sedative. d. Prostaglandin E does not repair the heart and the baby will require surgery shortly after birth.

Student Question Banks - Rudd Ch.12 6. The nurse is caring for a child diagnosed with Tetralogy of Fallot who is crying. As the crying continues, she becomes cyanotic. What is the nurse's best response? a. Apply supplemental oxygen b. Administer a sedative c. Hold the baby over the nurse's shoulder with knees to chest d. Place the baby on her abdomen and stroke her back

a. Supplemental oxygen will not correct this child's hypoxia. b. The child is likely to be receiving regular sedation and administering more could reduce respiratory effort. This is not the best response. c. CORRECT - Holding the baby upright with knees to chest improves perfusion and oxygenation. d. This may calm the baby but will not resolve the problem.

The patient with chronic heart failure is being discharged from the hospital. What information should the nurse emphasize in the patient's discharge teaching to prevent progression of the disease to ADHF? a. Take medications as prescribed. b. Use oxygen when feeling short of breath. c. Only ask the physician's office questions. d. Encourage most activity in the morning when rested.

a. Take medications as prescribed. The goal for the patient with chronic HF is to avoid exacerbations and hospitalization. Taking the medications as prescribed along with nondrug therapies such as alternating activity with rest will help the patient meet this goal. If the patient needs to use oxygen at home, it will probably be used all the time or with activity to prevent respiratory acidosis. Many HF patients are monitored by a care manager or in a transitional program to assess the patient for medication effectiveness and monitor for patient deterioration and encourage the patient. This nurse manager can be asked questions or can contact the health care provider if there is evidence of worsening HF.

Student Question Banks - Rudd Ch.12 11. The mother of a premature newborn asks the nurse if her baby has a genetic defect. The nurse would say the disorder is not genetic if the baby has what cardiac anomaly? a. Tetralogy of Fallot b. Coarctation of the aorta c. Patent ductus arteriosus d. Hypopolastic left heart

a. Tetralogy of Fallot does have a genetic component. b. Coarctation of the aorta would be a genetic disorder. c. CORRECT - Patent ductus arteriosus is seen often in premature infants, and while it closes on its own in most infants, this is not a genetic defect. d. Hypoplastic left heart does have a genetic component.

Student Question Banks - Rudd Ch.12 7. The nurse analyzes an ECG rhythm strip and notes an alteration in the S wave, indicating a problem with what? a. The left atrium b. The right atrium c. The left ventricle d. The right ventricle

a. The P wave indicates contraction of the atrium. b. The P wave indicates contraction of the atrium. c. The S wave does not represent the left ventricle. d. The S wave represents the contraction of the right ventricle, so an alteration would indicate a problem.

Student Question Banks - Rudd Ch.12 12. The nurse provides medication teaching to the parent of a child who will require digoxin after discharge. The nurse determines teaching was effective when the parent makes which statements? Select all that apply. a. I need to weigh my child weekly. b. I need to call the doctor if my child's weight increases more than 2 pounds per week. c. I should aminister the medication at the same time every day. d. I should give an extra dose if I ever miss a day. e. I should consult the pediatrician before administering any over-the-counter medication.

a. The child should be weighed daily. b. The doctor should be called if the child gains more than 2 pounds in 24 hours. c. CORRECT - This is a correct statement, indicating the parent understood teaching. d. The parent should not double up if a dose is missed. e. CORRECT - This is a correct statement, indicating the parents understood what the nurse taught them.

Student Question Banks - Rudd Ch.12 3. The mother of a child with a cardiac anomaly says to the nurse, "Look at how oddly shaped my son's fingers are. Is there something wrong with his hands?" The nurse looks at the child's fingers and see widening of the top of the finger with a distorted angle at the nail bed. How will the nurse respond? a. "It appears to be a form of arthritis, but I will ask the doctor to look at them." b. "It is edema caused by fluid overload. A diuretic will make that go away." c. "That is only one of the symptoms of a syndrome that your child has." d. "Children with chronically low oxygen levels develop fingers that look like that."

a. The child's fingers are assessed to be clubbing, which is not a form of arthritis. b. The child's fingers are clubbing, which is not caused by fluid overload. c. While this statement is vaguely correct, it does not explain what is happening. d. CORRECT - This is an accurate statement.

Student Question Banks - Rudd Ch.12 14. The nurse checks the 4-year-old child's blood pressure and obtains a reading of 86/78. How does the nurse interpret this blood pressure? a. Hypertension b. Fluid volume excess c. Low cardiac output d. Elevated stroke volume

a. This reading in a 4-year-old does not reflect an elevated blood pressure. b. An elevated blood pressure would be expected with fluid volume excess and this blood pressure is not high. c. CORRECT - Poor cardiac output will result in a low systolic blood pressure with a high diastolic pressure, creating a narrow pulse pressure. d. This reading does not indicate stroke volume.

Kaplan Congenital Heart Failure 2. The 6-month-old baby has a cyanotic congenital heart defect. The nurse knows that a cyanotic congenital heart defect is associated with which symptom? a. Pedal edema b. Clubbing of the fingers c. Obligate nose breathing d. Warm, dry skin

a. cyanotic congenital heart disease includes tetralogy of Fallot, transposition of the great vessels, truncus arteriosis, and total anomalous venous return; cyanotic heart defects cause poorly oxygenated venous blood to enter the systemic circulation; compensatory mechanisms include tachycardia, polycythemia, and posturing b. CORRECT - other symptoms that occur in clients with congenital heart defects include costal retractions and failure to thrive c. position of comfort for infants with hypoxemia is either flaccid with extremities extended or side-lying with knees toward chest d. hypoxemia will cause pale and dusky skin that is cool to the touch

IN MVS pulse is weak and often irregular because of

afib

Kaplan Congenital Heart Failure 1. Surgical repair of a congenital heart defect is performed on the 5-month-old infant. Which measure is MOST important for the nurse to include in the postoperative care plan? a. Administer pain medications to the client to prevent crying. b. Elevate the client's head to reduce respiratory effort. c. Administer laxatives to the client to prevent straining. d. Milk the chest tubes to maintain tube patency.

a. pain medication should be administered prior to treatments so that pain medication is at peak effect; for older child, use firm pillow or favorite stuffed animal to splint incision during coughing b. CORRECT - elevating the head of the bed assists with respiratory effort, and is an essential component of postoperative care c. not necessary d. immediately postop, drainage will be bright red, bur afterward should be serous; tubes removed second to third postop day

bruit

abnormal blowing or swishing sound heard during auscultation of an artery or organ

generated by turbulent flow of blood in artery due to partial obstruction

abnormal bruit hs

first stage hypertension

above 140/90

Peritonsillar abscess or quinsy is almost always secondary to

acute or recurrent tonsillitis.

most common cause of exudate pharyngitis in children

adenovirus

Considering known risks for cancer of larynx assess

alcohol intake hx

in a pre-surg interview w/ a patient dx'd laryngeal cancer assess

alcohol smoking and workplace hx

promotes the retention of Na+

aldosterone

Epleronone

aldosterone Antagonist

Angiotension II causes vasconstriction and stimulates

aldosterone production.

___ stimulates the secretion of K+ into ___

aldosterone; tubular lumen of kidney

PTCA NI pre op

allergies consent IV shave prep teaching.

stroke volume

amount of blood pumped per beat with each ventricle

what is ESV

amount of blood remaining in a ventricle after contraction (65 mL)

stroke volume

amount/ volume of blood pumped from a ventricle in one contraction/ heart beat

____ insufficiency characteristics = A diminished or absent pulse is a characteristic of ____ insufficiency. ___ insufficiency characteristics = superficial ulcer formation, aching/ cramping pain, and present pulses

arterial venous

Hypertrophic Cardiomyopathy (HCM)

an inherited condition in which there is an enlargement of the heart muscle, especially the muscle between the two ventricles

w/ s/p mvr, in which dental procedures would atbx be unnecessary

anesthetic inj, deciduous teeth removal or placement of Orthodontic Brackets "OBjections to Denatal Atbx"

Infarction may result from untreated

angina

52. Elastic ____________ stockings must be worn continuously for one week following vein stripping.

anti-embolitic

Promotes water retention by the kidneys

antidiuretic hormone

Ibuprofen and acetaminophen are not

antiplatelets

aspirin and clopidogrel

antiplatelets s/p stent

29. In addition to sublingual nitroglycerin, a patient experiencing chest pain due to angina will receive 160 to 325 mg of ____ to reduce risk of MI.

aspirin

25. A patient comes to the walk-in clinic reporting left anterior chest discomfort with mild shortness of breath. The patient is alert, oriented, diaphoretic, and anxious. What is the priority action for the nurse? a. Obtain a complete cardiac history to include a full description of the presenting symptoms. b. Place the patient in Fowler's position and start supplemental oxygen. c. Instruct the patient to go immediately to the closest full-service hospital. d. Immediately alert the physician and establish IV access.

b

Iggy Study Guide Ch.32 16. The nurse is caring for several postoperative patients with high risk for a PE. All of these patients have preexisting chronic respiratory problems. What is a unique assessment finding for a clot in the lung? a. Dyspnea b. Sudden dry cough c. Pursed-lip breathing d. Audible wheezing

b

29. The nurse is assessing a middle-aged woman with diabetes who denies any history of known heart problems. However, on auscultation of the heart the nurse hears an S4 heart sound. The nurse alerts the physician and obtains an order for which diagnostic test? a. Blood glucose level b. Electrocardiogram c. Chest x-ray d. Echocardiogram

b

3. A patient has been admitted for acute angina. which diagnostic test identifies if the patient will benefit from further invasive management after acute angina or an MI? a. Exercise tolerance test b. Cardiac catheterization c. Thallium scan d. Multigated angiogram (MUGA) scan

b

31. A patient had severe chest pain several hours ago but is currently pain-free and has a normal ECG. Which statement by the patient indicates a correct understanding of the significance of the ECG results? a. "I'll go home and make an appointment to see my family doctor next week." b. "The ECG could be normal since I am currently pain-free." c. "A normal ECG means I am okay." d. "I have always had a strong heart, low blood pressure, and a normal ECG."

b

36. During an annual physical exam, a patient receives an ECG and has an abnormal Q wave in several leads. What is the nurse's best interpretation of this result? a. The patient is experiencing a silent MI> b. The patient has experienced an MI in the past. c. The patient is having an acute MI at the moment. d. The patient is experiencing ischemia at the moment.

b

37. The home health nurse receives a call from a patient with CAD who reports having new onset of chest pain and shortness of breath. What does the nurse instruct the patient to do? a. Rest quietly until the nurse can arrive at the house to check the patient. b. Chew 325 mg of aspirin and immediately call 911. c. Use supplemental home oxygen until symptoms resolve. d. Take three nitroglycerin tablets and have family drive the patient to the hospital.

b

39. Which drug is given within 1 to 2 hours of an MI when the patient is hemodynamically stable, to help the heart to perform more work without ischemia? a. Vasodilators, such as sublingual or spray nitroglycerin (NGT) b. Beta-adrenergic blocking agents, such as metoprolol (Lopressor) c. Antiplatelet agents, such as clopidogrel (Plavix) d. Calcium channel blockers, such as diltiazem (Cardizem)

b

41. The health care provider is considering use of thrombolytic therapy for a patient. What is the criterion for this therapy? a. Chest pain of greater than 15 minutes duration that is unrelieved by nitroglycerin b. Indications of transmural ischemia and injury as shown by the ECG. c. Ventricular dysrhythmias shown on the cardiac monitor. d. HIstory of chronic, severe, poorly controlled hypertension

b

43. The health care provider is considering treating a 125-pound 76-year-old MI patient with thrombolytic therapy. What action does the nurse expect regarding this therapy for this patient? a. Due to her age, the patient will not receive this therapy. b. The thrombolytic therapy dosage may be decreased to decrease risk of bleeding. c. Heparin by continuous IV is the best choice after antiplatelet therapy with an aspirin. d. Because the MI is recent, the patient will receive the usual dosage of thrombolytic drug.

b

A patient with left-sided heart failure has oxygen at 4 L/min per nasal cannula, furosemide (Lasix) 40 mg PO daily, spironolactone (Aldactone) 25 mg PO daily, and enalapril (Vasotec) 5 mg PO twice daily. Which of the following actions is most important for the nurse to carry out? a. Assess skin turgor b. Auscultate lung sounds c. Measure intake and output d. Draw a blood sample for arterial blood gases

b

Iggy Study Guide Ch.31 64. A patient diagnosed with TB has been receiving treatment for 3 weeks and has clinically shown improvement. The family asks the nurse if the patient is still infectious. What is the nurse's reply? a. "The patient is till infectious until the entire treatment is completed." b. "The patient is not infectious but needs to continue treatment for at least 6 months." c. "The patient is infectious until there is a negative chest x-ray." d. "The patient may or may not be infectious; a purified protein derivative test (PPD) must be done."

b

Iggy Study Guide Ch.31 66. A patient with suspected TB is admitted to the hospital. Along with a private room which nursing intervention is appropriate related to isolation procedures? a. Respiratory isolation and contact isolation for sputum only b. Strict respiratory isolation and use of specially designed facemasks c. Respiratory isolation with surgical masks until diagnosis is confirmed d. No respiratory isolation necessary until diagnosis is confirmed.

b

Iggy Study Guide Ch.31 7. An older adult patient residing in a long-term care facility demonstrates new onset of coughing and sneezing with rhinorreha after his grandchildren came to visit him. He denies pain or fever. Which infection control procedures does the nurse instruct the LPN to initiate in order to protect the other residents? a. Initiate the use of standard precautions when caring for the patient. b. Place the patient on droplet precautions for the first 2 to 3 days. c. Use gown and gloves when entering the room and perform hand hygiene. d. Instruct the patient to wash his hands after coughing or sneezing.

b

Iggy Study Guide Ch.31 70. The nurse is making home visits to an older adult recovering from a hip fracture and identifies the priority patient problem of risk for respiratory infection. Which condition represents a factor of normal aging that would contribute to this increased risk? a. Inability to force a cough b. Decreased strength of respiratory muscles c. Increased elastic recoil of alveoli d. Increased macrophages in alveoli

b

Iggy Study Guide Ch.31 8. The nurse is assessing an older adult who has been diagnosed with bacterial pharyngitis. Which assessment finding is typically associated with this medical diagnosis, but may not be present in the older adult patient? a. Cough and rash b. High fever and elevated white blood cell (WBC) count c. Pain with speaking or swallowing d. Erythema of tonsils with yellow exudate

b

Iggy Study Guide Ch.32 11. A patient is being treated with heparin therapy for a PE. The patient has the potential for bleeding with the administration of heparin. What does the nurse monitor in relation to the heparin therapy? a. Lab values for any elevation of prothrombin time (PT) or partial thromboplastin time (PTT) value b. PTT values for greater than 2.5 times the control and/or the patient for bleeding. c. Occurrence of a pulmonary infarction by blood in sputum. d. PT values for International Normalized Ratio (INR) for a therapeutic range of 2 to 3 and/or the patient for bleeding.

b

Iggy Study Guide Ch.32 9. The provider orders heparin therapy for a patient with a relatively small PE. The patient states, "I didn't tell the doctor my complete medical history." Which condition may affect the provider's decision to immediately start heparin therapy? a. Type 2 diabetes mellitus b. Recent cerebral hemorrhage c. Newly diagnosed osteoarthritis d. Asthma since childhood

b

Lilley Ch.26 pg. 434-435 5. A patient has received a double dose of heparin during surgery and is bleeding through the incision site. While the surgeons are working to stop the bleeding at the incision site, the nurse will prepare to take what action at this time? a. Give IV vitamin K as an antidote. b. Give IV protamine sulfate as an antidote. c. Call the blood bank for an immediate platelet transfusion. d. Obtain on order for packed red blood cells.

b

Question 20 of 24 The nurse is overseeing a nursing student who is administering medications to a group of clients with pulmonary disorders. Which statement by the student nurse indicates a correct understanding about thrombolytic therapy? a. "You will receive a dose of enoxaparin (Lovenox) intramuscularly for 3 days." b. "Therapy with warfarin (Coumadin) is effective when your INR is between 2 and 3." c. "Once the health care provider orders warfarin (Coumadin), we will discontinue the intravenous heparin." d. "If bleeding develops, we will give you platelets to reverse the anticoagulant."

b "Therapy with warfarin (Coumadin) is effective when your INR is between 2 and 3." The international normalized ratio (INR), a measurement of anticoagulation with warfarin, is in the therapeutic range between 2 and 3. Enoxaparin (Lovenox) is a low-molecular-weight heparin that is usually given by the subcutaneous route. Heparin and warfarin are overlapped until the INR is in the therapeutic range, then the heparin can be discontinued. Fresh-frozen plasma is used as an antidote for anticoagulant therapy, not platelets.

Question 7 of 24 Which client needs immediate attention by the nurse? a. A 40-year-old who is receiving continuous positive airway pressure and has intermittent wheezing b. A 54-year-old who is mechanically ventilated and has tracheal deviation c. A 57-year-old who was recently extubated and is reporting a sore throat d. A 60-year-old who is receiving O2 by facemask and whose respiratory rate is 24 breaths/min

b A 54-year-old who is mechanically ventilated and has tracheal deviation The 54-year-old client is showing signs of a tension pneumothorax that could lead to decreased cardiac output and shock if not addressed promptly. The 40-year-old client has intermittent adventitious breath sounds, but is not in immediate danger or distress. The 57-year-old client has mild discomfort, but is not in danger of a life-threatening situation. The 60-year-old client has mild tachypnea, but is not in immediate distress or danger.

Question 2 of 24 The nurse is caring for a client with impending respiratory failure who refuses intubation and mechanical ventilation. Which method provides an alternative to mechanical ventilation? a. Oropharyngeal airway b. Bi-level positive airway pressure (BiPAP) c. Non-rebreather mask with 100% oxygen d. Positive end-expiratory pressure (PEEP)

b Bi-level positive airway pressure (BiPAP) BiPAP ventilation is a noninvasive method that may provide short-term ventilation without intubation. An oropharyngeal airway is used to prevent the tongue from occluding the airway or the client from biting the endotracheal tube. A non-rebreather mask will assist with oxygenation; however, muscle fatigue and hypoventilation may occur as causes of respiratory failure. The need for PEEP indicates a severe gas-exchange problem; this modality is "dialed in" on the mechanical ventilator.

Evolve 8. Before administering a dose of an antidysrhythmic drug to a patient, what is the priority nursing assessment? a. Measure urine output and specific gravity. b. Check apical pulse and blood pressure. c. Evaluate peripheral pulses and level of consciousness. d. Obtain temperature and pulse oximetry on room air.

b Check apical pulse and blood pressure. Antidysrhythmic drugs can cause both hypotension and bradycardia; therefore, it is important to assess blood pressure and apical pulse before administration.

Lilley Ch 26 NCLEX® Examination Questions 4. The nurse is giving discharge instructions to a patient prescribed warfarin (Coumadin) for atrial fibrillation. Which statement by the patient indicates a need for further instruction from the nurse? a. "I will take my medication in the early evening each day." b. "I will increase the dark green leafy vegetables in my diet." c. "I will contact my health care provider if I develop excessive bruising." d. "I will avoid activities that have a risk for injury such as contact sports."

b Dark green leafy vegetables are rich in vitamin K, which would antagonize the effects of warfarin. Therefore, it is important to maintain a consistent daily intake of vitamin K and avoid eating large amounts of these foods.

2. The nurse is caring for a group of clients who have sustained myocardial infarction (MI). The nurse observes the client with which type of MI most carefully for the development of left ventricular heart failure? a. Inferior wall b. Anterior wall c. Lateral wall d. Posterior wall

b Due to the large size of the anterior wall, the amount of tissue infarction may be large enough to decrease the force of contraction, leading to heart failure. The client with an inferior wall MI is more likely to develop right ventricular heart failure. Clients with obstruction of the circumflex artery may experience a lateral wall MI and sinus dysrhythmias or a posterior wall MI and sinus dysrhythmias.

6. After thrombolytic therapy, the nurse working in the cardiac catheterization laboratory would be alarmed to notice which sign? a. A 1-inch backup of blood in the IV tubing b. Facial drooping c. Partial thromboplastin time (PTT) 68 seconds d. Report of chest pressure during dye injection

b During and after thrombolytic administration, the nurse observes for any indications of bleeding, including changes in neurologic status, which may indicate intracranial bleeding. A 1-inch backup of blood in the IV tubing may be related to IV positioning. If heparin is used, PTT reflects a therapeutic value. Reports of chest pressure during dye injection or stent deployment are considered an expected result of the procedure.

Question 13 of 24 The client with which condition is in greatest need of immediate intubation? a. Difficulty swallowing oral secretions b. Hypoventilation and decreased breath sounds c. O2 saturation of 90% d. Thick, purulent secretions and crackles

b Hypoventilation and decreased breath sounds Intubation may be indicated for the client who is hypoventilating and has decreased breath sounds. Suctioning, rather than intubation, is indicated for difficulty swallowing secretions, as well as for thick, purulent secretions and crackles (consistent with pneumonia). Intubation is indicated for the client with an O2 saturation of less than 90% and other symptoms of hypoxemia or hypercarbia.

Lilley Ch 26 NCLEX® Examination Questions 13. While observing a patient self-administer enoxaparin (Lovenox), the nurse identifies the need for further teaching when the patient performs which self-injection action? a. Does not aspirate before injecting the medication b. Massages the site after administration of the medication c. Administers the medication into subcutaneous (fatty) tissue d. Injects the medication greater than 2 inches away from the umbilicus

b It is not recommended to massage the area of injection of anticoagulants because of the increased risk of hematoma formation.

10. The client in the cardiac care unit has had a large myocardial infarction. How does the nurse recognize onset of left ventricular failure? a. Urine output of 1500 mL on the preceding day b. Crackles in the lung fields c. Pedal edema d. Expectoration of yellow sputum

b Manifestations of left ventricular failure and pulmonary edema are noted by listening for crackles and identifying their locations in the lung fields. A urine output of 1500 mL is normal. Edema is a sign of right ventricular heart failure. Yellow sputum indicates the presence of white blood cells and possible infection.

Question 1 of 24 A client has been admitted for a pulmonary embolism and is receiving heparin infusion. What safety priority does the nurse include in the plan of care? a. Teach the client to avoid using dental floss. b. Monitor the platelet count daily. c. Ensure adequate staffing for the unit. d. Notify radiology of an impending scan.

b Monitor the platelet count daily. Daily platelet counts are a safety priority in assessing for thrombocytopenia; heparin-induced thrombocytopenia is a possible side effect. Avoiding the use of dental floss is important during anticoagulation therapy, but it is not the priority. Adequate staffing and notifying radiology are not the priority.

12. A client has just returned from coronary artery bypass graft surgery. For which finding does the nurse contact the surgeon? a. Temperature 98.2° F b. Chest tube drainage 175 mL last hour c. Serum potassium 3.9 mEq/L d. Incisional pain 6 on a scale of 0 to 10

b Some bleeding is expected after surgery; however, the nurse should report chest drainage over 150 mL/hr to the surgeon. Although hypothermia is a common problem after surgery, a temperature of 98.2° F is a normal finding. Serum potassium of 3.9 mEq/L is a normal finding. Incisional pain of 6 on a scale of 0 to 10 is expected immediately after major surgery; the nurse should administer prescribed analgesics.

5. Prompt pain management with myocardial infarction is essential for which reason? a. The discomfort will increase client anxiety and reduce coping. b. Pain relief improves oxygen supply and decreases oxygen demand. c. Relief of pain indicates that the MI is resolving. d. Pain medication should not be used until a definitive diagnosis has been established.

b The focus of pain relief is on reducing myocardial oxygen demand. Chest discomfort will increase anxiety, but it may not affect coping. Relief of pain is secondary to the use of opiates or indicates that the tissue infarction is complete. Although it used to be true that pain medication was not to be used for undiagnosed abdominal pain, this does not relate to MI.

Lilley Ch 26 NCLEX® Examination Questions 12. The nurse determines the patient has a good understanding of the discharge instructions regarding warfarin (Coumadin) with which patient statement? a. "I should keep taking ibuprofen for my arthritis." b. "I should use a soft toothbrush for dental hygiene." c. "I should decrease the dose if I start bruising easily." d. "I will double my dose if I forget to take it the day before."

b The patient should reduce the risk of bleeding, such as using a soft toothbrush. The other choices are inaccurate.

Question 21 of 24 The nurse is assessing a client who is receiving mechanical ventilation with positive end-expiratory pressure. Which findings would cause the nurse to suspect a left-sided tension pneumothorax? a. The chest caves in on inspiration and "puffs out" on expiration. b. The trachea is deviated to the right side and cyanosis is present. c. The left lung field is dull to percussion with crackles present on auscultation. d. The client has bloody sputum and wheezes.

b The trachea is deviated to the right side and cyanosis is present. Symptoms of tension pneumothorax include chest asymmetry, tracheal deviation toward the unaffected side, dyspnea, absent breath sounds, jugular venous distention, cyanosis, and hyperresonance to percussion over the affected area. Flail chest is manifested by paradoxical chest movement, which consists of "sucking inward" of the loose chest area during inspiration and "puffing out" of the same area during expiration. Open pneumothorax presents with decreased breath sounds, hyperresonance, and poor respiratory excursion on the affected side. Pulmonary contusion presents with hemoptysis, dullness to percussion, and crackles or wheezes.

9. The nurse in the coronary care unit is caring for a group of clients who have had myocardial infarction. Which client does the nurse see first? a. Client with dyspnea on exertion when ambulating to the bathroom b. Client with third-degree heart block on the monitor c. Client with normal sinus rhythm and PR interval of 0.28 second d. Client who refuses to take heparin or nitroglycerin

b Third-degree heart block is a serious complication that indicates that a large portion of the left ventricle and conduction system are involved, so the client with the third-degree heart block should be seen first. Third-degree heart block usually requires pacemaker insertion. A normal rhythm with prolonged PR interval indicates first-degree heart block, which usually does not require treatment. The client with dyspnea on exertion when ambulating to the bathroom is not at immediate risk. The client's uncooperative behavior when refusing to take heparin or nitroglycerin may indicate fear or denial; he should be seen after emergency situations have been handled.

Lilley Ch 26 NCLEX® Examination Questions 6. The nurse is preparing a patient with acute chest pain for an emergency angioplasty. The nurse would anticipate administering which medication to prevent platelet aggregation? a. Warfarin (Coumadin) b. Tirofiban (Aggrastat) c. Aminocaproic acid (Amicar) d. Protamine (Protamine sulfate)

b Tirofiban is a glycoprotein IIb/IIIa inhibitor that blocks the enzyme essential for platelet aggregation. This is given to prevent the formation of further clots and is faster acting than warfarin. Protamine sulfate is the antagonist for heparin, not an anticoagulant. Aminocaproic acid is an antifibrinolytic, the opposite of what is needed in this situation.

Lilley Ch 26 NCLEX® Examination Questions 2. The nurse is caring for a patient admitted with gastrointestinal bleeding who is anticoagulated with warfarin (Coumadin). Which medication should the nurse anticipate administering? a. Vitamin E b. Vitamin K (Phytonadione) c. Protamine (Protamine sulfate) d. Calcium gluconate

b Vitamin K is the antagonist for warfarin.

Question 19 of 24 When caring for a client with pulmonary embolism (PE), which arterial blood gas results does the nurse anticipate early in the course of the disease? a. pH 7.24, PaCO2 55 mm Hg, HCO3- 26 mEq/L, PaO2 56 mm Hg b. pH 7.46, PaCO2 30 mm Hg, HCO3- 26 mEq/L, PaO2 68 mm Hg c. pH 7.35, PaCO2 45 mm Hg, HCO3- 24 mEq/L, PaO2 80 mm Hg d. pH 7.47, PaCO2 35 mm Hg, HCO3- 30 mEq/L, PaO2 75 mm Hg

b pH 7.46, PaCO2 30 mm Hg, HCO3- 26 mEq/L, PaO2 68 mm Hg Hyperventilation triggered by hypoxia and pain first leads to respiratory alkalosis, indicated by a low partial pressure of arterial carbon dioxide (PaCO2 of 30 mm Hg) and a high pH (7.46). No compensation is present as the bicarbonate (HCO3-) (26 mEq/L) is normal, and hypoxemia is present, consistent with PE. A pH of 7.24 is acidotic, a partial pressure of arterial oxygen (PaO2) of 56 mm Hg reflects hypoxemia, and no compensation is present with a normal HCO3- (26 mEq/L); this blood would be found in a person in acute respiratory failure owing to hypoventilation and hypoxemia. A pH between 7.35 and 7.45, PaCO2 of 35 to 45 mm Hg, HCO3- of 22 to 26 mEq/L, and PaO2 greater than 75 mm Hg all reflect normal blood gas results. A pH of 7.47 and an HCO3- of 30 mEq/L are alkalotic, indicating metabolic alkalosis; a PaCO2 of 35 mm Hg is normal (indicating lack of compensation) and a PaO2 of 75 mm Hg is normal.

Rudd Ch.12 Pg.246-247 Review Questions 7. The most common congenital heart defect is a. coarctation of the aorta b. ventricular septal defect c. tetralogy of Fallot d. Truncus arteriosus

b ventricular septal defect

A client complains of leg pain brought on by walking several blocks — a symptom that first arose several weeks earlier. The client's history includes diabetes mellitus and a two-pack-per-day cigarette habit for the past 42 years. The physician diagnoses intermittent claudication and orders pentoxifylline (Trental), 400 mg three times daily with meals. Which instruction concerning long-term care should the nurse provide? a) "See the physician if complications occur." b) "Practice meticulous foot care." c) "Consider cutting down on your smoking." d) "Reduce your level of exercise."

b) "Practice meticulous foot care." Explanation: Intermittent claudication and other chronic peripheral vascular diseases reduce oxygenation to the feet, making them susceptible to injury and poor healing. Therefore, meticulous foot care is essential. The nurse should teach the client to bathe his feet in warm water and dry them thoroughly, cut the toenails straight across, wear well-fitting shoes, and avoid taking medications without the approval of a physician. Because nicotine is a vasoconstrictor, this client should stop smoking, not just consider cutting down. Daily walking is beneficial to clients with intermittent claudication. To evaluate the effectiveness of the therapeutic regimen, this client should see the physician regularly, not just when complications occur.

Which of the following diagnostic tests are used to quantify venous reflux and calf muscle pump ejection? a) Lymphangiography b) Air plethysmography c) Lymphoscintigraphy d) Contrast phlebography

b) Air plethysmography Explanation: Air plethysmography is used to quantify venous reflux and calf muscle pump action. Contrast phlebography involves injecting a radiopaque contrast agent into the venous system. Lymphoscintigraphy is done when a radioactively labeled colloid is injected subcutaneously in the second interdigital space. The extremity is then exercised to facilitate the uptake of the colloid by the lymphatic system, and serial images are obtained at present intervals. Lymphoangiography provides a way of detecting lymph node involvement resulting from metastatic carcinoma, lymphoma, or infection in sites that are otherwise inaccessible to the examiner except by surgery.

A home health nurse is seeing an elderly female client for the first time. During the physical assessment of the client's feet, the nurse notes several circular ulcers around the tips of the toes on both feet. The bases of the ulcers are pale, and the client reports the ulcers to be very painful. From these assessment findings, the nurse suspects that the cause of the ulcers is which of the following? a) Neither venous nor arterial b) Arterial insufficiency c) Trauma d) Venous insufficiency

b) Arterial insufficiency Explanation: Characteristics of arterial insuffiency ulcers include location at the tips of the toes, extreme painfulness, and circular shape with pale to black ulcer bases. Ulcers caused by venous insufficiency will be irregular in shape, minimal pain if superficial (can be painful), and usually located around the ankles or the anterier tibial area.

Which of the following is a characteristic of an arterial ulcer? a) Brawny edema b) Border regular and well demarcated c) Ankle-brachial index (ABI) > 0.90 d) Edema may be severe

b) Border regular and well demarcated Explanation: Characteristics of an arterial ulcer include a border that is regular and demarcated. Brawny edema, ABI > 0.90, and edema that may be severe are characteristics of a venous ulcer.

A client is hospitalized for repair of an abdominal aortic aneurysm. The nurse must be alert for signs and symptoms of aneurysm rupture and thus looks for which of the following? a) Slow heart rate and high blood pressure b) Constant, intense back pain and falling blood pressure c) Constant, intense headache and falling blood pressure d) Higher than normal blood pressure and falling hematocrit

b) Constant, intense back pain and falling blood pressure Explanation: Indications of a rupturing abdominal aortic aneurysm include constant, intense back pain; falling blood pressure; and decreasing hematocrit.

A home health nurse is teaching a client with peripheral arterial disease ways to improve circulation to the lower extremities. The nurse encourages which of the following in teaching? a) Elevation of the legs above the heart b) Keeping the legs in a neutral or dependent position c) Application of ace wraps from the toe to below the knees d) Use of antiembolytic stockings

b) Keeping the legs in a neutral or dependent position Explanation: Keeping the legs in a neutral or dependent position assists in delivery of arterial blood from the heart to the lower extremities. All the other choices will aid in venous return, but will hinder arterial supply to the lower extremities.

Postpericardiotomy syndrome may occur in patients who undergo cardiac surgery. The nurse should be alert to which of the following clinical manifestations associated with this syndrome? a) Decreased white blood cell (WBC) count b) Pericardial friction rub c) Decreased erythrocyte sedimentation rate (ESR) d) Hypothermia

b) Pericardial friction rub Explanation: The syndrome is characterized by fever, pericardial pain, pleural pain, dyspnea, pericardial effusion, pericardial friction rub, and arthralgia. Leukocytosis (elevated WBCs) occurs, along with elevation of the ESR.

The patient has had biomarkers drawn after complaining of chest pain. Which diagnostic of myocardial infarction remains elevated for as long as 3 weeks? a) Total CK b) Myoglobin c) Troponin d) CK-MB

b) Troponin Explanation: Troponin remains elevated for a long period, often as long as 3 weeks, and it therefore can be used to detect recent myocardial damage. Myoglobin returns to normal in 12 hours. Total CK returns to normal in 3 days. CK-MB returns to normal in 3 to 4 days

Two days after undergoing a total abdominal hysterectomy, a client complains of left calf pain. Venography reveals deep vein thrombosis (DVT). When assessing this client, the nurse is likely to detect: a) loss of hair on the lower portion of the left leg. b) left calf circumference 1" (2.5 cm) larger than the right. c) pallor and coolness of the left foot. d) a decrease in the left pedal pulse.

b) left calf circumference 1" (2.5 cm) larger than the right. Explanation: Signs of DVT include inflammation and edema in the affected extremity, causing its circumference to exceed that of the opposite extremity. Pallor, coolness, decreased pulse, and hair loss in an extremity signal interrupted arterial blood flow, which doesn't occur in DVT.

Patients with a heart transplantation are at risk for which complications in the first year after transplantation (select all that apply)? a. cancer b. infection c. rejection d. vasculopathy e. sudden cardiac death

b, c, & e Rationale: A variety of complications can occur after heart transplantation. In the first year after transplantation, the major causes of death are acute rejection and infection. Heart transplant recipients also are at risk for sudden cardiac death. Later, malignancy (especially lymphoma) and cardiac vasculopathy (accelerated CAD) are major causes of death.

Question 14 of 24 Which components belong to the ventilator bundle approach to prevent ventilator-associated pneumonia (VAP)? Select all that apply. a. Administering antibiotic prophylaxis b. Continuous removal of subglottic secretions c. Elevating the head of the bed at least 30 degrees whenever possible d. Handwashing before and after contact with the client e. Placing a nasogastric tube f. Placing the client in a negative-airflow room

b, c, d Continuous removal of subglottic secretions, Elevating the head of the bed at least 30 degrees whenever possible, Handwashing before and after contact with the client

Question 8 of 24 The nurse coming on shift prepares to perform an initial assessment of a sedated, ventilated client. Which are priorities for the nurse to carry out? Select all that apply. a. Ask visitors to leave. b. Assess the client's color and respirations. c. Confirm alarms and ventilator settings. d. Ensure that the tube cuff is inflated and is in the proper position. e. Listen for bilateral breath sounds. f. Provide routine tracheotomy and endotracheotomy and mouth care.

b, c, d, e Assess the client's color and respirations. Confirm alarms and ventilator settings. Ensure that the tube cuff is inflated and is in the proper position. Listen for bilateral breath sounds. The first priority when caring for a critically ill client is to assess airway and breathing. Alarm settings should be confirmed each shift, more frequently if necessary. Confirming that the client cannot speak ensures that air is going through the endotracheal tube and not around it. Auscultating for equal bilateral breath sounds assists in confirming that the tube is above the carina. Having visitors remain with the client may promote comfort and prevent confusion. Routine tracheostomy care is performed according to schedule, not necessarily as part of an initial assessment.

P. 409 6. When the nurse is teaching a patient about taking an antidysrhythmic drug, which statements by the nurse are correct? (Select all that apply.) a. "Take the medication with an antacid if stomach upset occurs." b. "Do not chew sustained-release capsules." c. "If weight gains of 5 pounds within 1 week occurs, notify your physician at the next office visit." d. "If you experience severe adverse effects, stop the drug and notify your physician." e. "You may take the medication with food if stomach upset occurs."

b, e

Iggy Study Guide Ch.31 54. Which statements about the precautions of caring for a hospitalized patient with tuberculosis (TB) are true? (Select all that apply.) a. Health care workers must wear a mask that covers the face and mouth. b. Negative airflow rooms are required for these patients. c. Health care workers must wear an N95 or high-efficiency particulate air (HEPA) mask. d. Gown and gloves are included in appropriate barrier protection. e. Strict contact precautions must be maintianed.

b,c,d

Lilley Ch.26 pg. 434-435 6. A patient is starting warfarin (Coumadin) therapy as part of treatment for atrial fibrillation. The nurse will follow which principles of warfarin therapy? (Select all that apply.) a. Teach proper subcutaneous administration. b. Administer the oral dose at the same time every day. c. Assess carefully for excessive bruising or unusual bleeding. d. Monitor laboratory results for a target INR of 2 to 3. e. Monitor laboratory results for a therapeutic aPTT value of 1.5 to 2.5 times the control value.

b,c,d

21. Which characteristics place women at high risk for myocardial infarction (MI)? (Select all that apply.) a. Premenopausal b. Increasing age c. Family history d. Abdominal obesity e. Breast cancer

b,c,d Increasing age is a risk factor, especially after 70 years. Family history is a significant risk factor in both men and women. A large waist size and/or abdominal obesity are risk factors for both metabolic syndrome and MI. Premenopausal women are not at higher risk for MI, and breast cancer is not a risk factor for MI.

23. Which atypical symptoms may be present in a female client experiencing myocardial infarction (MI)? (Select all that apply.) a. Sharp, inspiratory chest pain b. Dyspnea c. Dizziness d. Extreme fatigue e. Anorexia

b,c,d Many women who experience an MI present with dyspnea, light-headedness, and fatigue. Sharp, pleuritic pain is more consistent with pericarditis or pulmonary embolism. Anorexia is neither a typical nor an atypical sign of MI.

14. The nurse is caring for a patient admitted with unstable angina and elevated lipid levels. What does the nurse include in teaching this patient about his or her elevated lipid levels? (Select all that apply.) a. Begin a vigorous exercise program b. Avoid trans-fatty acids. c. Reduce intake of saturated fats. d. Monitor the amount of cholesterol intested, staying below 200 mg/day. e. consider a weight loss program.

b,c,d,e

Iggy Study Guide Ch.32 21. What does the nurse monitor for in a patient with a PE? (Select all that apply.) a. Nausea and vomiting b. Cyanosis c. Rapid heart rate d. Dyspnea e. Pradoxical chest movement f. Crackles in the lung fiels

b,c,d,f

Iggy Study Guide Ch.31 69. Patients who are at high risk for TB would be asked which questions upon assessment? (Select all that apply.) a. "What does your diet normally consist of?" b. "Do you have an immune dysfunction or HIV?" c. "Do you use alcohol or inject recreational drugs?" d. "Do you work in a crowded area such as a prison or mental health facility?"

b,c,e

Iggy Study Guide Ch.32 12. Acute respiratory failure is classified by which critical values of PaCO2? (Select all that apply.) a. 39 mm Hg b. 52 mm Hg c. < 60 mm Hg d. 77 mm Hg e. > 50 mm Hg with a pH value of < 7.3

b,c,e

Iggy Study Guide Ch.32 35. The nurse is performing patient teaching for a patient who will be taking anticoagulants at home. What does the nurse include in the instructions? (Select all that apply.) a. Use a soft-bristled toothbrush and floss frequently. b. Do not take aspirin or any aspirin-containing products. c. Do not participate in activities that will cause bumps, scratches, or scrapes. d. If you are bumped, apply ice to the site for at least 24 hours. e. Eat warm, cool, or cold foods to avoid burning your mouth. f. If you must blow your nose, do so gently without blocking either nasal passage.

b,c,e,f

5. A patient with angina is prescribed nitroglycerin tablets. What information does the nurse include when teaching the patient about this drug? (Select all that apply.) a. "If one tablet does not relieve the angina after 5 minutes, take two pills." b. "You can tell the pills are active when your tongue feels a tingling sensation." c. "Keep your nitroglycerin with you at all times." d. "The prescription should last about 6 months before a refill is necessary." e. "If pain doesn't go away, just wait; the medication will eventually take effect." f. "The medication can cause a temporary headache."

b,c,f

33. The ED nurse is caring for a patient with acute pain associated with MI. What are the purposes of collaborative management that address the patient's pain? (Select all that apply.) a. Return the vital signs and cardiac rhythm to baseline, so the patient can resume activities of daily living. b. Prevent further damage to the cardiac muscle by decreasing myocardial oxygen demand and increasing myocardial oxygen supply. c. Aggressively diagnose and treat life-threatening cardiac dysrhythmias and restore pulmonary wedge pressure. d. Closely monitor the patient for accompanying symptoms such as nausea and vomiting or indigestion. e. Eliminate discomfort by providing pain relief modalities, decrease myocardial oxygen demand, and increase myocardial oxygen supply.

b,e

25. The nurse is concerned that a client who had myocardial infarction (MI) has developed cardiogenic shock. Which findings indicate shock? (Select all that apply.) a. Bradycardia b. Cool, diaphoretic skin c. Crackles in the lung fields d. Respiratory rate of 12 breaths/min e. Anxiety and restlessness f. Temperature of 100.4° F

b,e,e The client with shock has cool, moist skin. Because of extensive tissue necrosis, the left ventricle cannot forward blood adequately, resulting in pulmonary congestion and crackles. Because of poor tissue perfusion, a change in mental status, anxiety, and restlessness are expected. All types of shock (except neurogenic) present with tachycardia, not bradycardia. Due to pulmonary congestion, a client with cardiogenic shock typically has tachypnea. Cardiogenic shock does not present with low-grade fever; this would be more likely to occur in pericarditis.

*Of the following respiratory system structures which one does not distribute air?* A. bronchiole B. alveolus C. bronchus D. Trachea

b. Alveolus

The P wave represents: a. Atrial repolarization b. Atrial depolarization c. Ventricular depolarization

b. Atrial depolarization-the impulse spreading across the atria generates a P wave

A P wave on an ECG represents an impulse arising at the a. SA node and repolarizing the atria. b. SA node and depolarizing the atria. c. AV node and depolarizing the atria d. AV node and spreading to the bundle of his

b. SA node and depolarizing the atria.

When collecting subjective data related to the cardiovascular system, which information should be obtained from the patient (select all that apply)? a. annual income b. smoking history c. religious preference d. number of pillows used to sleep e. blood for basic lab studies

b. Smoking history c. Religious preference d. Number of pillows used to sleep

To gather information about impulse conduction from the atrial to the ventricles study the : a. P wave b. PR interval c. ST segment

b. The PR interval measures the interval between atrial depolarization and ventricular depolarization

The ausculatory area in the left midclavicular line at the level of the fifth ICS is the best location to hear sounds from which heart valve? a. aortic b. Mitral c. tricuspid d. pulmonic

b. mitral

angioplasty and stent

balloon in bv for expansion then stent in bv to holdhold vessel up

valve replacement surgery is replaced w/ either

biological tissue or mechanical valves

bvr abv as

biological valve replacement

PTT determines the

bleeding tendencies and effect of heparin

Beta Blockers MOA

blocks effects of the hormone epinephrine aka adrenaline. Beta blockers cause your heart to beat more slowly and with less force, which lowers blood pressure. Beta blockers also help open up your veins and arteries to improve blood flow.

35. The nurse is caring for a hospitalized patient being treated initially with IV nitroglycerin. What intervention must the nurse include in this patient's care? a. Increase the dose rapidly to achieve pain relief. b. Restrict the patient to bedrest with bedpan use. c. Monitor blood pressure continuously. d. Elevate the head of the bed to 90 degrees.

c

6. A patient reports chest pain that is unrelieved with a sublingual nitroglycerin tablet. What does the nurse administer next to this patient? a. Valium intramuscularly b. Morphine sulfate IV c. Supplemental oxygen d. Chewable aspirin

c

8. The nurse has just given a patient two doses of sublingual nitroglycerin for anginal pain. The patient's blood pressure is typically 130/80 mm Hg. which finding warrants immediate notification of the health care provider? a. Patient reports a headache b. Systolic pressure is 140 mm Hg c. systolic pressure is 90 mm Hg d. Anginal pain continues but is somewhat relieved

c

Iggy Study Guide Ch.31 10. A patient reporting a "sore throat" also has a temperature of 101.4F, scarlatiniform rash, and a positive rapid test throat culture. This patient will most likely be treated for which type of bacterial infection? a. Staphylococcus b. Pneumococcus c. Streptococcus d. Epstein-Barr virus

c

Iggy Study Guide Ch.31 59. A patient has a positive skin test result for TB. What explanation does the nurse give to the patient? a. "There is active disease, but you are not yet infectious to others." b. "There is active disease and you need immediate treatment." c. "You have been infected but this does not mean active disease is present." d. "A repeat skin test is necessary because the test could give a false-positive result."

c

Iggy Study Guide Ch.31 67. A patient is admitted to the hospital to rule out TB. What type of mask does the nurse wear when caring for this patient? a. Surgical facemask b. Surgical facemask with eye shield c. HEPA respirator mask d. any type of mask that covers the nose and mouth

c

Iggy Study Guide Ch.31 68. After being discharged from the hospital, a patient is diagnosed with TB at the outpatient clinic. What is the correct procedure regarding public health policy in this case? a. Contact the infection control nurse at the hospital because the hospital is responsible for follow-up of this case. b. There are no regulations because the patient was diagnosed at the clinic and not during hospitalization. c. Contact the public health nurse so that all individuals who have come in contact with the patient can be screened. d. Have the patient sign a waiver regarding the hospital and clinic's liability for treatment.

c

Iggy Study Guide Ch.32 17. The nurse is caring for several patients at risk for DVT and PE. Which condition causes the patient to be a candidate for placement of a vena cava filter? a. Massive PE causing the patient to experience shock symptoms b. Multiple emboli with deteriorating cardiopulmonary status c. Recurrent bleeding while receiving anticoagulants d. No response to oxygen therapy and conservative management

c

Iggy Study Guide Ch.32 22. After receiving IV heparin anticoagulant therapy, patients are generally not discharged from the hospital without a prescription and instructions for which drug? a. Protamine sulfate b. Prednisone (Eltasone) c. Warfarin (Coumadin) d. Oral heparin

c

Iggy Study Guide Ch.32 26. A patient recently receive anticoagulant therapy for complications of PE after knee surgery. The patient is now in a rehabilitation facility and is receiving warfarin (Coumadin). What is the nursing responsibility related to Coumadin? a. Having protamine sulfate available as an antidote b. Administering NSAIDs or aspirin for pain related to the knee c. Teaching the patient about foods high in vitamin K d. Monitoring platelets for thrmobocytopenia

c

Iggy Study Guide Ch.32 5. A patient in the hospital being treated for a PE is receiving a continuous infusion of heparin. When the nurse comes to take vital signs, the patient has blood on the front of his chest and nose, and is holding a tissue saturated with blood to his nose. What is the first priority action the nurse must take? a. Have the patient sit up and lean forward, pinching the nostrils. b. Have a patient care technician set up oral suctioning to suction excess blood from patient's mouth. c. Stop the heparin IV infusion. d. Obtain laboratory results for prothrombin time and complete blood count.

c

Iggy Study Guide Ch.32 51. A postoperative patient reports sudden onset of shortness of breath and pleuritic chest pain. Assessment findings include diaphoresis, hypotension, crackles in the left lower lob, and pulse oximetry of 85%. What does the nurse suspect has occured with this patient? a. Atelectasis b. Pneumothorax c. Pulmonary embolism d. Flail chest

c

Iggy Study Guide Ch.32 6. The nurse's young neighbor who smokes is going on an overseas flight. The neighbor knows he is at risk for DVT and PE, and asks the nurse for advice. What does the nurse suggest? a. Exercise regularly and walk around before boarding the flight. b. Get a prescription for heparin therapy and take it before the flight. c. Drink water and get up every hour for at least 5 minutes during the flight. d. Elevate the legs as much as possible during and after the flight.

c

Rudd Ch.12 Pg.246-247 Review Questions 6. The caregiver of a child with tetralogy of Fallot (TOF) notes that her child consistently squats, and asks why. The nurs should provide the following information to answer this caregiver's question: a. "Your child is squatting because he want you to carry him." b. "Your child is squatting because TOF results in leg pain." c. "It increases the circulation to the child's lungs." d. "The knee-chest position results in increased inferior vena cava pressure."

c "It increases the circulation to the child's lungs."

Question 23 of 24 The nurse is teaching the family of a client who is receiving mechanical ventilation. Which statement reflects appropriate information that the nurse should communicate? a. "Sedation is needed so your loved one does not rip the breathing tube out." b. "Suctioning is important to remove organisms from the lower airway." c. "Paralysis and sedatives help decrease the demand for oxygen." d. "We are encouraging oral and IV fluids to keep your loved one hydrated."

c "Paralysis and sedatives help decrease the demand for oxygen." Paralytics and sedation decrease oxygen demand. Sedation is needed more for its effects on oxygenation than to prevent the client from ripping out the endotracheal tube. Suctioning is performed to maintain airway patency. Minimizing fluids while administering diuretics leads to better outcomes.

Question 10 of 24 The nurse is caring for a group of clients. Which person does the nurse identify as having the highest risk for pulmonary embolism (PE)? a. A client with diabetes and cellulitis of the leg b. A client receiving IV fluids through a peripheral line c. A client returning from an open reduction and internal fixation of the tibia d. A client with hypokalemia receiving potassium supplements

c A client returning from an open reduction and internal fixation of the tibia Surgery and immobility are risks for deep vein thrombosis and PE. No evidence suggests that the client with diabetes has been immobile, which is a risk factor for PE; the client will be treated with antibiotics. For the client with a peripheral line, no evidence indicates a problem with the IV or with breakage of the catheter, which could lead to an air embolism. For the client with hypokalemia, no evidence reveals risk for PE; no immobility or hyper-coagulability is present.

Question 17 of 24 Which critically ill client has the greatest risk for developing acute respiratory distress syndrome (ARDS)? a. Client with diabetic ketoacidosis (DKA) b. Client with atrial fibrillation c. Client with aspiration pneumonia d. Client with acute kidney failure

c Client with aspiration pneumonia Aspiration of acidic gastric contents is a risk for ARDS. Clients with DKA may develop metabolic acidosis, but not ARDS, which develops in lung injury. Atrial fibrillation does not cause lung injury unless embolization occurs. Acute kidney failure results in metabolic acidosis, not in acute lung injury.

15. An older adult client, 4 hours after coronary artery bypass graft (CABG), has a blood pressure of 80/50 mm Hg. What action does the nurse take? a. No action is required; low blood pressure is normal for older adults. b. No action is required for postsurgical CABG clients. c. Assess pulmonary artery wedge pressure (PAWP). d. Give ordered loop diuretics.

c Decreased preload as exhibited by decreased PAWP could indicate hypovolemia secondary to hemorrhage or vasodilation; hypotension could cause the graft to collapse. Low blood pressure is not normal in older adults or postoperative clients. The cause of hypotension must be found and treated; further action is needed to determine additional interventions. Hypotension could be caused by hypovolemia; giving loop diuretics increases hypovolemia.

13. The visiting nurse is seeing a client postoperative for coronary artery bypass graft. Which nursing action should be performed first? a. Assess coping skills. b. Assess for postoperative pain at the client's incision site. c. Monitor for dysrhythmias. d. Monitor mental status.

c Dysrhythmias are the leading cause of prehospital death; the nurse should monitor the client's heart rhythm. Assessing mental status, coping skills, or postoperative pain is not the priority for this client.

Question 18 of 24 The nurse is developing a plan of care for a client with pulmonary embolism (PE). Which client problem does the nurse establish as the priority? a. Inadequate nutrition related to food-drug interactions and anticoagulant therapy b. Potential for infection related to leukocytosis c. Hypoxemia related to ventilation-perfusion mismatch d. Insufficient knowledge related to the cause of PE

c Hypoxemia related to ventilation-perfusion mismatch Restoring adequate oxygenation and tissue perfusion takes priority when a client presents with a PE. Although nutrition must be addressed, priorities include airway, breathing, and circulation. The client has a leukocytosis related to lung inflammation; leukopenia places clients at risk for infection, but this is not the priority at this time. Education as to the cause of PE must be postponed until oxygenation and hemodynamic stability occur.

pH High N // CO2 N // HCO3 UP

compensated metabolic alkalosis

Question 15 of 24 The nurse is caring for a client who is receiving mechanical ventilation and hears the high-pressure alarm. Which action should the nurse take first? a. Check the ventilator alarm settings. b. Assess the set tidal volume. c. Listen to the client's breath sounds. d. Call the respiratory therapist.

c Listen to the client's breath sounds. A typical reason for the high-pressure alarm to sound is the need for suctioning or tension pneumothorax. The nurse should begin the assessment with the client, not with the ventilator. Although an excessively high tidal volume could contribute to sounding of the high-pressure alarm, assessment always begins with the client. The professional nurse possesses the skill to assess ventilator alarms; waiting for the respiratory therapist delays intervention.

11. A client undergoing coronary artery bypass grafting asks why the surgeon has chosen to use the internal mammary artery for the surgery. Which response by the nurse is correct? a. "This way you will not need to have a leg incision." b. "The surgeon prefers this approach because it is easier." c. "These arteries remain open longer." d. "The surgeon has chosen this approach because of your age."

c Mammary arteries remain patent much longer than other grafts. Although no leg incision will be made with this approach, veins from the legs do not remain patent as long as the mammary artery graft does. Long-term patency, not ease of the procedure, is the primary concern. Age is not a determining factor in selection of these grafts.

7. The nurse is caring for a client in phase 1 cardiac rehabilitation. Which activity does the nurse suggest? a. The need to increase activities slowly at home b. Planning and participating in a walking program c. Placing a chair in the shower for independent hygiene d. Consultation with social worker for disability planning

c Phase 1 begins with the acute illness and ends with discharge from the hospital; it focuses on promoting rest and allowing clients to improve their activities of daily living based on their abilities. Phase 2 begins after discharge and continues through convalescence at home, including consultation with a social worker for long-term planning; it consists of achieving and maintaining a vital and productive life while remaining within the limits of the heart's ability to respond to increases in activity and stress. Phase 3 refers to long-term conditioning, such as a walking program.

20. An LPN/LVN is scheduled to work on the inpatient "stepdown" cardiac unit. Which client does the charge nurse assign to the LPN/LVN? a. A 60-year-old who was admitted today for pacemaker insertion because of third-degree heart block and who is now reporting chest pain b. A 62-year-old who underwent open heart surgery 4 days ago for mitral valve replacement and who has a temperature of 38.2° C c. A 66-year-old who has a prescription for a nitroglycerin (Nitro-Dur) patch and is scheduled for discharge to a group home later today d. A 69-year-old who had a stent placed 2 hours ago in the left anterior descending artery and who has bursts of ventricular tachycardia

c The LPN/LVN scope of practice includes administration of medications to stable clients. Third-degree heart block is characterized by a very low heart rate and usually by required pacemaker insertion; the skills of the RN are needed to care for this client. Fever after surgery requires collaboration with the health care provider, which is more consistent with the role of the RN. The client with a recent stent placement and having bursts of ventricular tachycardia is unstable and is showing ventricular irritability; he will need medications and monitoring beyond the scope of practice of the LPN/LVN.

3. The nurse is teaching a group of teens about prevention of heart disease. Which point should the nurse emphasize? a. Reduce abdominal fat. b. Avoid stress. c. Do not smoke or chew tobacco. d. Avoid alcoholic beverages.

c Tobacco exposure, including secondhand smoke, reduces coronary blood flow; causes vasoconstriction, endothelial dysfunction, and thickening of the vessel walls; increases carbon monoxide; and decreases oxygen. Because it is highly addicting, beginning smoking in the teen years may lead to decades of exposure. Teens are not likely to experience metabolic syndrome from obesity, but are very likely to use tobacco. Avoiding stress is a less modifiable risk factor, which is less likely to cause heart disease in teens. The risk of smoking outweighs the risk of alcohol use.

A client complains of leg pain brought on by walking several blocks — a symptom that first arose several weeks earlier. The client's history includes diabetes mellitus and a two-pack-per-day cigarette habit for the past 42 years. The physician diagnoses intermittent claudication and orders pentoxifylline (Trental), 400 mg three times daily with meals. Which instruction concerning long-term care should the nurse provide? a) "Reduce your level of exercise." b) "See the physician if complications occur." c) "Practice meticulous foot care." d) "Consider cutting down on your smoking."

c) "Practice meticulous foot care." Explanation: Intermittent claudication and other chronic peripheral vascular diseases reduce oxygenation to the feet, making them susceptible to injury and poor healing. Therefore, meticulous foot care is essential. The nurse should teach the client to bathe his feet in warm water and dry them thoroughly, cut the toenails straight across, wear well-fitting shoes, and avoid taking medications without the approval of a physician. Because nicotine is a vasoconstrictor, this client should stop smoking, not just consider cutting down. Daily walking is beneficial to clients with intermittent claudication. To evaluate the effectiveness of the therapeutic regimen, this client should see the physician regularly, not just when complications occur.

In a patient with a bypass graft, the distal outflow vessel must be at least what percentage patent for the graft to remain patent? a) 40 b) 30 c) 50 d) 20

c) 50 Explanation: The distal outflow vessel must be at least 50% patent for the graft to remain patent.

When teaching a client with peripheral vascular disease about foot care, a nurse should include which instruction? a) Avoid using cornstarch on the feet. b) Avoid using a nail clipper to cut toenails. c) Avoid wearing canvas shoes. d) Avoid wearing cotton socks.

c) Avoid wearing canvas shoes. Explanation: The client should be instructed to avoid wearing canvas shoes. Canvas shoes cause the feet to perspire, and perspiration can cause skin irritation and breakdown. Cotton and cornstarch absorb perspiration. The client should be instructed to cut toenails straight across with nail clippers.

Which of the following are characteristics of arterial insufficiency? a) Aching, cramping pain b) Superficial ulcer c) Diminished or absent pulses d) Pulses are present, may be difficult to palpate

c) Diminished or absent pulses Explanation: A diminished or absent pulse is a characteristic of arterial insufficiency. Venous characteristics include superficial ulcer formation, an aching and cramping pain, and presence of pulses.

A physician orders blood coagulation tests to evaluate a client's blood-clotting ability. The nurse knows that such tests are important in assessing clients at risk for thrombi, such as those with a history of atrial fibrillation, infective endocarditis, prosthetic heart valves, or myocardial infarction. Which test determines a client's response to oral anticoagulant drugs? a) Bleeding time b) Platelet count c) Prothrombin time (PT) d) Partial thromboplastin time (PTT)

c) Prothrombin time (PT) Explanation: PT determines a client's response to oral anticoagulant therapy. This test measures the time required for a fibrin clot to form in a citrated plasma sample following addition of calcium ions and tissue thromboplastin and compares this time with the fibrin-clotting time in a control sample. The physician should adjust anticoagulant dosages as needed, to maintain PT at 1.5 to 2.5 times the control value. Bleeding time indicates how long it takes for a small puncture wound to stop bleeding. The platelet count reflects the number of circulating platelets in venous or arterial blood. PTT determines the effectiveness of heparin therapy and helps physicians evaluate bleeding tendencies. Physicians diagnose appoximately 99% of bleeding disorders on the basis of PT and PTT values.

A physician admits a client to the health care facility for treatment of an abdominal aortic aneurysm. When planning this client's care, which goal should the nurse keep in mind as she formulates interventions? a) Increasing blood pressure and monitoring fluid intake and output b) Decreasing blood pressure and increasing mobility c) Stabilizing heart rate and blood pressure and easing anxiety d) Increasing blood pressure and reducing mobility

c) Stabilizing heart rate and blood pressure and easing anxiety Explanation: For a client with an aneurysm, nursing interventions focus on preventing aneurysm rupture by stabilizing heart rate and blood pressure. Easing anxiety also is important because anxiety and increased stimulation may raise the heart rate and boost blood pressure, precipitating aneurysm rupture. The client with an abdominal aortic aneurysm is typically hypertensive, so the nurse should take measures to lower blood pressure, such as administering antihypertensive agents, as ordered, to prevent aneurysm rupture. To sustain major organ perfusion, the client should maintain a mean arterial pressure of at least 60 mm Hg. Although the nurse must assess each client's mobility individually, most clients need bed rest when initially attempting to gain stability.

A client with no known history of peripheral vascular disease comes to the emergency department complaining of sudden onset of lower leg pain. Inspection and palpation reveal absent pulses; paresthesia; and a mottled, cyanotic, cold, and cadaverous left calf. While the physician determines the appropriate therapy, the nurse should: a) elevate the affected leg as high as possible. b) place a heating pad around the affected calf. c) keep the affected leg level or slightly dependent. d) shave the affected leg in anticipation of surgery.

c) keep the affected leg level or slightly dependent. Explanation: While the physician makes treatment decisions, the nurse should maintain the client on bed rest, keeping the affected leg level or slightly dependent (to aid circulation) and protecting it from pressure and other trauma. Warming the leg with a heating pad (or chilling it with an ice pack) would further compromise tissue perfusion and increase injury to the leg. Elevating the leg would worsen tissue ischemia. Shaving an ischemic leg could cause accidental trauma from cuts or nicks.

2. A patient with a history of angina is admitted for surgery. The patient reports nausea, pressure in the chest radiating to the left arm, appears anxious, skin is cool and clammy, blood pressure is 150/90 mm Hg, pulse is 100, and respiratory rate is 32. What are the priorities of nursing care for this patient? (Select all that apply.) a. Relieve nausea b. Maintain NPO status c. Improve coronary perfusion d. Improve coronary oxygenation e. Relieve chest pain

c,d,e

What is the priority assessment by the nurse caring for a patient receiving IV nesiritide (Natrecor) to treat heart failure? a. Urine output b. Lung sounds c. Blood pressure d. Respiratory rate

c. Blood pressure Although all identified assessments are appropriate for a patient receiving IV nesiritide, the priority assessment would be monitoring for hypotension, the main adverse effect of nesiritide.

A compensatory mechanism involved in HF that leads to inappropriate fluid retention and additional workload of the heart is: a. ventricular dilation b. ventricular hypertrophy c. neurohormonal response d. sympathetic nervous system activation

c. neurohormonal response Rationale: The following mechanisms in heart failure lead to inappropriate fluid retention and additional workload of the heart: activation of the renin-angiotensin-aldosterone system (RAAS) cascade and release of antidiuretic hormone from the posterior pituitary gland in response to low cerebral perfusion pressure that results from low cardiac output.

decreasing heart workload by decreasing heart muscle contraction/ HR

ca+ channel blockers

most prev cvd

cad

mitral stenosis

calcified mitral valve impedes forward flow of blood into left ventricle during diastole and back up causes pulmonary hypertension

Beta-adrenergic agonists

can increase lean mass and decrease stored fat

Newborn does not have enough smooth muscle bundles, so what occurs?

can't help trap airway invaders (bacteria/viruses/irritants)

Automaticity

cardiac muscle cells ability to contract without stimulation from the nervous system.

18. ____ ____ is the product of the heart multiplied by the stroke volume.

cardiac output

Diversion of blood from the heart and lungs by a mechanical device

cardiopulmonary bypass

cardiac surgery requires the absence of blood from the surgical field. At the same time, it is imperative to maintain perfusion of body organs and tissues

cardiopulmonary bypass

imperative to maintain perfusion of body organs and tissues

cardiopulmonary bypass

temporarily circulates and oxygenates a patient's blood during the portion of heart surgery where the heart is stopped

cardiopulmonary bypass

used to circulate and oxygenate blood mechanically while bypassing the heart and lungs

cardiopulmonary bypass

Beta-adrenergic agonists

cause a sympathetic response (use with caution in pregnant, elderly, clients with: renal dysfunction, hyperthyroidism, prostatic hypertrophy, hypertension, and Glaucoma) Do NOT take any over the counter drugs without consulting physician

Anti-diuretic Hormone (ADH)

causes H20 retention found in pituitary Any condition that can lead to increased ICP can cause ADH problems

RAAS (renin-angiotensin-aldosterone system)

causes vasoCONSTRICTION and sodium & water RETENTION

unstable angina

chest pain at rest or chest pain of increasing frequency

Stable angina

chest pain occuring when person is active or under severe stress

Unstable Angina (UA)

chest pain that is new in onset, occurs at rest, or has a worsening pattern

CPT stands for

chest physical therapy

What does clubbing indicate?

chronic hypoxia due to cardiac/pulmonary disease. The degree of proliferation of tissue above finger at skin nail junction)

common in people who suffer from chronic cough

chronic pharyngitis

what are the three varieties of lipoproteins

chylomicrons LDLs HDLs

H2 antagonists

cimetidine (tagamet) famotidine (pepcid) nizatidine (axid) rantidine (zantac)

51. The hallmark symptom of arterial insufficiency of the lower extremities is intermittent ____________.

claudication

risk for thrombosis/ platelet aggregation s/p stent = "except aspirin"

clopidogrel

Etiology of Sinus Arrhythmia

common in children and young adults increase in HR on inspiration decrease on expiration Usually benign

first degree AV node block

conduction of AV node >0.20 second long PR interval

what are the three types of capillaries

continuous fenestrated discontinuous

First action for electrical injury

continuous heart monitor for 24 hours (at risk for Vfib) Monitor for neurological deficits

Noninvasive Positive-Pressure Ventilation - CPAP

continuous positive airway pressure (CPAP); used to open collapsed alveoli; used for those with atelectasis after surgery or cardiac-induced pulmonary edema, COPD or sleep apnea

arteriovenous anastomoses

control cutaneous blood flow through surface capillaries close during cold or sympathetic NS open during heat and exercise

gray erthyematous margins that ulcerate similar lesions elsewhere

coxsaki virus viral pharyngitis

20. Hypertensive ____ is a situation in which blood pressure is very elevated but there is no evidence of impending target organ damage.

crisis

Nasalcrom aka

cromolyn for allergic rhinitis

inhibits release of histamine/ chemicals

cromolyn for allergic rhinitis

Conductivity is the ability of the cell to.......

transmit an electrical impulse to another cardiac cell

4. The nurse is talking to a patient with angina about resuming sexual activity. which statement by the patient indicates a correct understanding about the effects of angina on sexual activity? a. "I won't be able to resume the same level of physical exertion as I did before I had chest pain." b. "I will discuss alternative methods with my partner since I will no longer be able to have sexual intercourse." c. "If I cannot walk a mile, I am not strong enough to resume intercourse." d. "With approval from my health care provider, I should resume sexual activity in the mornings or after a rest period."

d

5. Which of the following indicates a positive finding for orthostatic systolic blood pressure changes? a. Drop of less than 20 mm Hg b. Increase of greater than 20 mm Hg c. Increase of 10 mm Hg d. Decrease of 10 mm Hg

d

Iggy Study Guide Ch.31 11. A patient reporting soreness in the throat is diagnosed with "Strep throat." To prevent complications such as rheumatic heart disease, this patient should receive which interventions? a. Humidification of the air b. Saline gargles 4 to 6 times a day c. Increased fluid intake of 3 to 4 L/day d. Oral antibiotics such as penicillin

d

Iggy Study Guide Ch.31 58. After receiving the subcutanous Mantoux skin test, a patient with no risk factors returns to the clinic in the required 48 to 72 hours for the test results. Which assessment finding indicates a positive result? a. Test area is red, warm, and tender to touch b. Induration or a hard nodule of any size at the site c. Induration/hardened area measures 5 mm or greater d. Induration/hardened area measures 10 mm or greater

d

Iggy Study Guide Ch.31 60. A patient has been compliant with drug therapy for TB and has returned as instructed for follow-up. Which result indicates that the patient is no longer infectious/communicable? a. Negative chest x-ray b. No clinical symptoms c. Negative skin test d. Three negative sputum cultures

d

Iggy Study Guide Ch.31 61. A patient diagnosed with TB agrees to take the medication as instructed and to complete the therapy. When does the nurse tell the patient is the best time to take the medication? a. Before breakfast b. After breakfast c. Midday d. Bedtime

d

Iggy Study Guide Ch.32 10. A patient with a PE asks for an explanation of heparin therapy. What is the nurse's best response? a. "It keeps the clot from getting larger by preventing platelets from sticking together to improve blood flow." b. "It will improve your breathing and decrease chest pain by dissolving the clot in your lung." c. "It promotes the absorption of the clot in your leg that originally caused the PE." d. "It increase the time it takes for blood to clot, therefore preventing further clotting and improving blood flow."

d

Iggy Study Guide Ch.32 13. Upon diagnosis of a PE, the nurse expects to perform which therapeutic intervention for the patient? a. Oral anticoagulant therapy b. Bedrest in the supine position c. Oxygen therapy via mechanical ventilator d. Parenteral anticoagulant therapy

d

Iggy Study Guide Ch.32 18. A patient with a massive PE has hypotension and shock, and is receiving IV crystalloids. However, the patient's cardiac output is not improving. The nurse anticipates an order for which drug? a. Hydromorphone (Dialudid) b. alteplase (Activase, tPA) c. Diltiazem (Cardizem) d. Dobutamine (Dobutrex)

d

Iggy Study Guide Ch.32 20. A patient with a PE is receiving anticoagulant therapy. Which assessment related to the therapy does the nurse perform? a. Measure abdominal girth because the medication causes fluid retention. b. Check skin turgor because dehydration contributes to anticoagulation. c. Monitor for nausea, vomiting, and diarrhea. d. Examine skin every 2 hours for evidence of bleeding.

d

The nurse cares for the client on continuous intravenous aminophylline. The nurse notes the client's IV is infusing too rapidly. The nurse should assess for which finding? A. Increased bronchospasm with wheezing. B. Kidney failure with elevated BUN. C. Bradycardia with cardiac arrest. RIGHT D. CNS excitation with seizure activity.

d

Question 5 of 24 A client was intubated 30 minutes ago for acute respiratory distress syndrome and possible sepsis. The following orders have been given for the client. In what sequence would the nurse perform these orders for this client? 1. Infuse levofloxacin (Levaquin) 500 mg IV. 2. Obtain baseline aerobic and anaerobic sputum cultures. 3. Teach the client and family methods of communicating. 4. Analyze postintubation arterial blood gases (ABGs). a. 2, 1, 3, 4 b. 4, 3, 1, 2 c. 3, 4, 2, 1 d. 4, 2, 1, 3

d 4, 2, 1, 3 ABGs should be analyzed first before the other assessments/actions are carried out. A baseline of sputum cultures should then be obtained before medications are administered. Then levofloxacin can be given. Client and family education on communication methods is important, but is the lowest priority here.

Lilley Ch 26 NCLEX® Examination Questions 8. The patient asks the nurse, "What is the difference between dalteparin (Fragmin) and heparin?" What is the nurse's best response? a. "There is really no difference, but dalteparin is preferred because it is less expensive." b. "I'm not really sure why some health care providers choose dalteparin and some heparin." c. "The only difference is that the heparin dosage calculation is based on the patient's weight." d. "Dalteparin is a low-molecular-weight heparin that has a more predictable anticoagulant effect."

d A low-molecular-weight heparin is more predictable in its effect than regular heparin. Dalteparin is more expensive than heparin and is dosed based on the patient's weight.

Evolve 3. The nurse is reviewing the protocol for administration of IV adenosine (Adenocard). What is the MOST important nursing intervention to remember when giving this medication? a. Monitor the infusion site for hematoma. b. Assess for burning sensation at the IV site. c. Flush the IV catheter with normal saline. d. Administer it as a fast IV push.

d Administer it as a fast IV push. Adenosine must be given as rapidly as possible because it has an extremely short half-life of less than 10 seconds. For this reason, it is administered only IV and only as a fast IV push.

A stable patient with acute decompensated heart failure (ADHF) suddenly becomes dyspneic. Before positioning the patient on the bedside, what should the nurse assess first? a. Urine output b. Heart rhythm c. Breath sounds d. Blood pressure

d. Blood pressure The nurse should evaluate the blood pressure before dangling the patient on the bedside because the blood pressure can decrease as blood pools in the periphery and preload decreases. If the patient's blood pressure is low or marginal, the nurse should put the patient in the semi-Fowler's position and use other measures to improve gas exchange.

14. During discharge planning after admission for a myocardial infarction, the client says, "I won't be able to increase my activity level. I live in an apartment, and there is no place to walk." What is the nurse's best response? a. "You are right. Work on your diet then." b. "You must find someplace to walk." c. "Walk around the edge of your apartment complex." d. "Where might you be able to walk?"

d Asking the client where he or she might be able to walk calls for cooperation and participation from the client; increased activity is imperative for this client. Telling the client to work on diet is an inappropriate response. Telling the client to find someplace to walk is too demanding to be therapeutic. Telling the client to walk around the apartment complex is domineering and will not likely achieve cooperation from the client.

4. To validate that a client has had a myocardial infarction (MI), the nurse assesses for positive findings on which tests? a. Creatine kinase-MB fraction (CK-MB) and alkaline phosphatase b. Homocysteine and C-reactive protein c. Total cholesterol, low-density lipoprotein cholesterol, and high-density lipoprotein cholesterol d. CK-MB and troponin

d CK-MB and troponin are the cardiac markers used to determine whether MI has occurred. Alkaline phosphatase is often elevated in liver disease. Homocysteine and C-reactive protein are markers of inflammation, which may represent risk for MI, but they are not diagnostic for MI. Elevated cholesterol levels are risks for MI, but they do not validate that an MI has occurred.

Evolve 9. Which drug class is used to treat both hypertension and antidysrhythmias? a. Direct-acting vasodilators b. Alpha-adrenergic-blocking c. Sodium channel blockers d. Calcium channel blockers

d Calcium channel blockers Calcium channel blockers are effective in treating both hypertension and dysrhythmias secondary to their negative inotropic and chronotropic effects.

Evolve 6. Sodium channel blockers are considered which class of antidysrhythmic drugs? a. Class III b. Class II c. Class IV d. Class I

d Class I The Vaughan Williams classification is the most commonly used system to classify antidysrhythmic drugs. There are four major classes of antidysrhythmic drugs: I, II, III, and IV. Sodium channel blockers are classified as class I drugs.

Evolve 10. Calcium channel blockers have which pharmacodynamic effect? a. Positive chronotropic b. Shortened refractory period c. Positive inotropic d. Coronary vasodilation

d Coronary vasodilation Calcium channel blockers cause coronary vasodilation, a negative inotropic effect, a negative chronotropic effect, and a negative dromotropic effect.

Lilley Ch 26 NCLEX® Examination Questions 7. Enoxaparin sodium (Lovenox) is an anticoagulant used to prevent and treat deep vein thrombosis and pulmonary embolism. This medication is in which drug class? a. Thrombolytic drug b. Oral anticoagulant c. Glycoprotein IIb/IIIa inhibitor d. Low-molecular-weight heparin

d Enoxaparin is a low-molecular-weight heparin.

Lilley Ch 26 NCLEX® Examination Questions 1. The nurse would assess which laboratory value to determine the effectiveness of intravenous heparin (Hemochron)? a. Prothrombin time (PT) b. Blood urea nitrogen c. Complete blood count d. Activated partial thromboplastin time (aPTT)

d Heparin dosing is based on aPTT results. The PT is reflective of warfarin's anticoagulant effect.

Lilley Ch 26 NCLEX® Examination Questions 9. Before emergency surgery, the nurse would anticipate administering which medication to a patient receiving heparin? a. Vitamin K (Phytonadione) b. Vitamin E c. Phenytoin (Dilantin) d. Protamine (Protamine sulfate)

d Protamine sulfate binds with heparin in the bloodstream to inactivate it and thus reverse its effect.

Evolve 11. The nurse is caring for a patient prescribed amiodarone (Cordarone). The nurse knows the MOST serious adverse effect of this medication can occur in which body system? a. Immune b. Nervous c. Gastrointestinal d. Respiratory

d Respiratory Pulmonary toxicity is the most serious potential adverse effect of amiodarone.

16. The nurse is assessing a client with chest pain to evaluate whether the client is suffering from angina or myocardial infarction (MI). Which symptom is indicative of an MI? a. Chest pain brought on by exertion or stress b. Substernal chest discomfort occurring at rest c. Substernal chest discomfort relieved by nitroglycerin or rest d. Substernal chest pressure relieved only by opioids

d Substernal chest pressure relieved only by opioids is typically indicative of MI. Substernal chest discomfort that occurs at rest is not necessarily indicative of MI; it could be a sign of unstable angina. Both chest pain brought on by exertion or stress and substernal chest discomfort relieved by nitroglycerin or rest are indicative of angina.

8. The nurse is caring for a client 36 hours after coronary artery bypass grafting, with a priority problem of intolerance for activity related to imbalance of myocardial oxygen supply and demand. Which finding causes the nurse to terminate an activity and return the client to bed? a. Pulse 60 beats/min and regular b. Urinary frequency c. Incisional discomfort d. Respiratory rate 28 breaths/min

d Tachypnea and tachycardia reflect activity intolerance; activity should be terminated. Pulse 60 beats/min and regular is a normal finding. Urinary frequency may indicate infection or diuretic use, but not activity intolerance. Pain with activity after surgery is anticipated; pain medication should be available.

Question 22 of 24 The nurse is caring for a client who was discharged 3 weeks ago after a diagnosis of pulmonary embolism (PE). He is currently admitted with gastrointestinal (GI) bleeding and an international normalized ratio (INR) of 6.9. For which factors should the nurse assess this client? a. Consumption of green leafy vegetables b. Prolonged exhalation c. Client has massaged his calves d. Use of aspirin or salicylates

d Use of aspirin or salicylates Use of aspirin and salicylates will prolong the INR and cause gastric irritation. Green leafy vegetables are high in vitamin K and would antagonize warfarin, resulting in a low(er) INR. A prolonged expiratory phase is typical in chronic obstructive pulmonary disease, not GI bleeding or a prolonged INR. Massaging the calves may present a risk for PE if deep vein thrombosis is present, but does not relate to GI bleeding and prolonged INR.

High Flow Oxygen Systems - Venture Mask

delivers most accurate O2 w/o intubation; works by pulling proportional amount of room air for each liter flow of O2; adaptor located between bottom of mask and oxygen source; each adaptor uses different flow rate; humidification not needed; best used with chronic lung disease because of more precise O2 concentration

Lilley Ch 26 NCLEX® Examination Questions 11. A patient is prescribed oral anticoagulant therapy while still receiving IV heparin infusion. The patient is concerned about risk for bleeding. What is the nurse's best response? a. "Bleeding is a common adverse effect of taking warfarin. If bleeding occurs, your health care provider will prescribe an injection of medication to stop the bleeding." b. "Because you are now getting out of bed and walking around, you have a higher risk of blood clot formation and therefore need to be on both medications." c. "Because of your mechanical valve replacement, it is especially important for you to be fully anticoagulated, and the heparin and warfarin together are more effective than one alone." d. "It usually takes 4 to 5 days to achieve a full therapeutic effect for warfarin, so the heparin infusion is continued to help prevent blood clots until the warfarin reaches its therapeutic effect."

d Warfarin works by decreasing the production of clotting factors. However, it takes 4 to 5 days for the body to use up present clotting factors and thus achieve a full therapeutic anticoagulant effect. Because of this, heparin is continued until this is achieved

Rudd Ch.12 Pg.246-247 Review Questions 8. Too small of a blood pressure cuff will result in a. a falsely low BP reading b. a correct BP reading - the cuff size has no effect on the blood pressure. c. an increased systolic BP d. a falsely high BP reading

d a falsely high BP reading

Which of the following medications is considered a thrombolytic? a) Heparin b) Lovenox c) Coumadin d) Alteplase

d) Alteplase Explanation: Alteplase is considered a thrombolytic, which lyses and dissolves thrombi. Thrombolytic therapy is most effective when given within the first 3 days after acute thrombosis. Heparin, Coumadin, and Lovenox do not lyse clots.

Which of the following is the hallmark symptom for peripheral arterial disease (PAD) in the lower extremity? a) Vertigo b) Dizziness c) Acute limb ischemia d) Intermittent claudication

d) Intermittent claudication Explanation: The hallmark symptom of PAD in the lower extremity is intermittent claudication. This pain may be described as aching or cramping in a muscle that occurs with the same degree of exercise or activity and is relieved with rest. Acute limb ischemia is a sudden decrease in limb perfusion, which produces new or worsening symptoms that may threaten limb viability. Dizziness and vertigo are associated with upper extremity arterial occlusive disease.

A female client is readmitted to the facility with a warm, tender, reddened area on her right calf. Which contributing factor should the nurse recognize as most important? a) An active daily walking program b) A history of diabetes mellitus c) History of increased aspirin use d) Recent pelvic surgery

d) Recent pelvic surgery Explanation: The client shows signs of deep vein thrombosis (DVT). The pelvic area has a rich blood supply, and thrombophlebitis of the deep veins is associated with pelvic surgery. Aspirin, an antiplatelet agent, and an active walking program help decrease the client's risk of DVT. In general, diabetes mellitus is a contributing factor associated with peripheral vascular disease.

When the patient diagnosed with angina pectoris complains that he is experiencing chest pain more frequently even at rest, the period of pain is longer, and it takes less stress for the pain to occur, the nurse recognizes that the patient is describing which type of angina? a) Variant b) Refractory c) Intractable d) Unstable

d) Unstable Explanation: Unstable angina is also called crescendo or preinfarction angina and indicates the need for a change in treatment. Intractable or refractory angina produces severe, incapacitating chest pain that does not respond to conventional treatment. Variant angina is described as pain at rest with reversible ST-segment elevation and is thought to be caused by coronary artery vasospasm. Intractable or refractory angina produces severe, incapacitating chest pain that does not respond to conventional treatment.

A client with no known history of peripheral vascular disease comes to the emergency department complaining of sudden onset of lower leg pain. Inspection and palpation reveal absent pulses; paresthesia; and a mottled, cyanotic, cold, and cadaverous left calf. While the physician determines the appropriate therapy, the nurse should: a) place a heating pad around the affected calf. b) elevate the affected leg as high as possible. c) shave the affected leg in anticipation of surgery. d) keep the affected leg level or slightly dependent.

d) keep the affected leg level or slightly dependent. Explanation: While the physician makes treatment decisions, the nurse should maintain the client on bed rest, keeping the affected leg level or slightly dependent (to aid circulation) and protecting it from pressure and other trauma. Warming the leg with a heating pad (or chilling it with an ice pack) would further compromise tissue perfusion and increase injury to the leg. Elevating the leg would worsen tissue ischemia. Shaving an ischemic leg could cause accidental trauma from cuts or nicks.

30. A middle-aged patient with no known medical problems has acute-onset chest pain and dyspnea. In order to rule out acute MI, the nurse obtains orders for which diagnostic tests? (Select all that apply.) a. Triglyceride levels and C-reactive protein b. Chest x-ray c. Total serum cholesterol, low-density lipoprotein, high-density lipoprotein d. Troponin T and I e. Creatine kinase -MB f. Arterial blood gases

d,e

The nurse is administering a dose of digoxin (Lanoxin) to a patient with heart failure (HF). The nurse would become concerned with the possibility of digitalis toxicity if the patient reported which symptom(s)? a. Muscle aches b. Constipation c. Pounding headache d. Anorexia and nausea

d. Anorexia and nausea Anorexia, nausea, vomiting, blurred or yellow vision, and cardiac dysrhythmias are all signs of digitalis toxicity. The nurse would become concerned and notify the health care provider if the patient exhibited any of these symptoms.

Beyond the first year after a heart transplant, the nurse knows that what is a major cause of death? a. Infection b. Acute rejection c. Immunosuppression d. Cardiac vasculopathy

d. Cardiac vasculopathy Beyond the first year after a heart transplant, malignancy (especially lymphoma) and cardiac vasculopathy (accelerated CAD) are the major causes of death. During the first year after transplant, infection and acute rejection are the major causes of death. Immunosuppressive therapy will be used for posttransplant management to prevent rejection and increases the patient's risk of an infection.

A male patient with a long-standing history of heart failure has recently qualified for hospice care. What measure should the nurse now prioritize when providing care for this patient? a. Taper the patient off his current medications. b. Continue education for the patient and his family. c. Pursue experimental therapies or surgical options. d. Choose interventions to promote comfort and prevent suffering.

d. Choose interventions to promote comfort and prevent suffering. The central focus of hospice care is the promotion of comfort and the prevention of suffering. Patient education should continue, but providing comfort is paramount. Medications should be continued unless they are not tolerated. Experimental therapies and surgeries are not commonly used in the care of hospice patients.

17. Which diagnostic tests are used to assess myocardial damage caused by an MI? (Select all that apply.) a. Positive chest x-ray b. Creatine kinase (CK) elevation c. ECG: ST depression d. CK-MB isoenzymes elevation e. Troponin I isoenzyme elevation

d.e

Partial thickness (2nd degree)

damage entire epidermis and varying depths of dermis

superficial thickness (first degree)

damage epidermis

Full thickness (3rd degree)

damage to entire dermis and sometimes fat

eschar

dead tissue

Clinical signs of junctional tachy

decrease CO

by blocking beta receptors it

decrease heart rate and dilates arteries

Manifestation of HF because of decreased cardiac output

decrease in perfusion of brain, lungs, coronary arteries, kidneys, and extremities

Signs and sx of Vtach

decrease level of consciousness sweating dizzy anxiety angina dyspnea If patient with Vtach go directly to patient and check pulse!

9. Higher HDL levels are associated with _____ risk for coronary artery disease.

decreased

Renin is secreted in response to

decreased blood pressure/ volume

Overall actions of parasympathetic system

decreases depolarization of SA node lengthens pause of AV node decreases atrial contraction

what are baroreceptors most sensitive to

decreases in BP sudden changes in BP

rapid heart rate...

decreases stroke volume

Clinical signs and symptoms of atrial flutter

depends on ventricular rate may experience palpitations, angina, or dyspnea Regular pulse!!

When auscultating during respiratory assessment do you use diaphragm or bell? and why?

diaphragm -greater quantity of sound, sensitive to high-pitched sounds

6. During _____, the heart chambers fill with blood in preparation for ejection.

diastole

mean arterial pressure (MAP)

diastolic + 1/3(systolic-diastolic) 93.33 mmHg

Angioplasty — balloon is inflated to open the vessel. Angioplasty and stent placement — After the balloon is used, a mesh frame called a stent will be placed in the vessel to support the walls. Atherectomy — The plaque is removed using a rotating shaver or laser.

difference between angioplasty and atherectomy

(ACE) inhibitors in patients with angina pectoris. Reduction of preload and afterload and a sympatholytic action may diminish myocardial oxygen demand.

diminish myocardial oxygen demand.

preload, contractility, afterload

directly affect sv

17. The recommended initial medication regime for patients with uncomplicated hypertension includes _____ and beta-blockers, or both.

diuretics

Low Flow Oxygen Systems

do not provide enough flow of oxygen to meet the total oxygen need and air volume of pt; part of tidal volume Is supplied by breathing room air; total level of oxygen inspired depends on respiratory rate and tidal volume; Types: nasal cannula or prongs, simple facemask, partial rebreather mask, non rebreather mask

septal defects

ductus arteriosus or foramen oval don't completely close right after birth; blood flows through ventricles

unexplained weight loss hx of smoking prompts

dx testing for cancer

angiogram

dye injected into blood stream so blood vessel of heart can be viewed

symptoms most closely associated with late signs of laryngeal cancer?

dyspnea dysphagia and lumps

EF

ejection fraction

38. Symptoms of heart failure are related to fluid ____ and inadequate tissue perfusion.

excess

edema

excessive accumulation of interstitial fluid

tonsillectomy and adenoidectomy

excision of tonsils and adenoids

PAWP is measured at the end of

expiration

overall actions of sympathetic system

faster depolarization to SA node shortens pause at AV node increases strength of contraction

Femur fx complication

fat emboli

Arab cultural considerations

females avoid eye contact with males touch accepted by same sex decisions made by males refuse organ donation do not eat pork avoid hot/cold drinks colostrum considered harmful to newborn

during clotting __ coverts to ___

fibrinogen converts to fibrin

risk includes Re occlusion of artery

fibrinolytic tx and post PTCA

insoluble protein fibrin formed from plasma protein fibrinogen during clotting and forms

fibrous mesh that impedes the flow of blood.

T Lymphocytes and monocytes infiltrate lipids at arterial wall and die causing

fibrous tissue

7. The point of maximum impulse (PMI) is normally palpable in the left midcalvicular line at the _____ intercostal space.

fifth

High Flow Oxygen Systems - Face Tent

fits over chin, with tip extending halfway across face; oxygen level delivered varies, but tent is useful for facial trauma or burns

stable angina pectoris

fixed artherosclerotic lesion. ∙*Symptoms*: pain with pressure with exertion. lasting 1-15 min and improved with rest. ∙*Diagnosis*: EKG usually normal. Stress test. Cardiac catherization. Coronary Angiography. ∙*Treatment*: lifestyle modification, aspirin, beta blockers, nitrates revascularization.

Poiselle's Law

flow rate inversely proportional to resistance resistance directly proportional to vessel length

41. The purpose of ____ restriction in the heart failure patient is to reduce circulating blood volume.

fluid

re-canalization

formation of new canals or paths, especially blood vessels, through an obstruction such as a clot

Aldosterone

found in adrenal glands help retain Na & H2o

what's the difference in pressure in capillaries

from 37 mmHg to 17 mmHg

what part of the ECG represents atrial events

from P to Q

what part of the ECG refers to ventricular events

from QRS complex to T

what is the transport of chylomicrons

from intestines to tissues

what is the transport of LDLs

from liver to tissues

In Systolic HF the LV loses its ability to

generate enough pressureeject blood forward through aorta

Adrenal cortex

glucocorticoids mineral corticoids sex hormones

Insulin carries ______ & _______ into the cell

glucose & K+

gtt is abv. For and aka

glucose tolerance test aka pancreas test

ACS (acute coronary syndrome)

group of conditions caused by decreased blood flow through the coronary arteries (STEMI, NSTEMI, unstable angina)

High Flow Oxygen Systems

have flow rate that meets the entire oxygen need and tidal volume regardless of the patient's breathing patter; used for critically ill patients and when delivery of precise levels of oxygen is needed; delivers oxygen 24-100%; Types: venture mask, face tent, aerosol mask, tracheostomy collar, T-piece

NI for lacking cerebral perfusion

head between legs

What 2 signs are severe?

head bobbing and grunting

HCM aka..

hypertrophic cardiomyopathy

Clinical manifestations of Pulmonary Edema

increased RR Tachypnea SOB increase PaCO2 decreased PaO2

Cardiac Glycoside MOA

increased force of Contraction Increase CO and renal perfusion increase urine output and decrease blood volume

Etiology of Atrial Flutter

increased sympathetic Tone Atrial Stimulation hyperthyroidism

slower heart rate...

increases EDV and SV

Angiotensin II

increases blood pressure by stimulating kidneys to reabsorb more water and by releasing aldosterone

total laryngectomy priority nsg dx

ineffective airway clearance r/t airway alterations = risk for aspiration

hyperglycemia causes

inflammatory changes in bv

difference between angioplasty and atherectomy

inflated balloon opens bv then meshy stent removes plaque using rotating shaver or laser

Management of acute laryngitis includes

inhaling cool steam/ aerosol, rest, resting voice, avoiding irritants smoking and warm steam/ aerosol

what do atrial stretch receptors do

inhibit ADH release so that kidneys secrete more fluid and blood volume is decreased also secrete ANP

what does atrial natriuretic peptide (ANP) do

inhibits aldosterone, promoting salt and water excretion and promote vasodilation

Cromolyn for allergic rhinitis

inhibits release of histamine/ chemicals

plaques form on inner lumen of arterial walls

inner lumen of arterial walls

Etiology of second degree type II AV block

insult to AV node MI hypoxemia "cardiac drugs"

Etiology of Second Degree Type I AV block

insult to AV node inferior MI hypoxemia

Etiology of Junctional (escape) Rhythm

insult to SA node hypoxemia DIGITALIS toxicity

Anticoagulant

interferes with clotting cascade and thrombin formation Used for pt with thromboembolic disorders

What are functional problems of a respiratory assessment?

involve alterations in gas exchange and threats to gas exchange from irritants i.e., large particles, chemicals, invaders i.e., viruses or bacteria

What are Structural problems of a respiratory assessment?

involve alterations in the size and shape of parts of the respiratory tract

When giving IV Ca+, always make sure client

is on a heart monitor

what is the effect of norepinephrine on blood flow

it activates alpha 1 receptors located on the smooth muscle on the outside of the blood vessel to constrict it

what is the effect of epinephrine on blood flow

it activates beta 2 receptors inside the blood vessel to dilate it

what happens to the coronary vessel during systole

it completely flattens and has no blood in it

what happens to the length of diastole during exercise

it decreases

what happens to your blood pressure as you go form lying to standing

it drops negative feedback response from baroreceptors increases BP

secrete renin

juxatolomerluar

When BP, fluid or sodium level falls,

juxatolomerluar cells secrete renin

A pacemaker's primary function is to.......?

keep the ventricles beating at a rate that maintains sufficient blood pressure and perfuse all organs adequately

when the body breaks down protein & fat it produces _____, which are ________

ketones which are acids

The diastolic pressure represents the

minimum amount of pressure that is always present in the arteries.

PVS considered dangerous when

more than 6 a minute Bigeminy/Trigeminy paired or runs multiformed In the presence of acute MI

drug for pt. w/ suspected MI aspirin, nitroglycerin, morphine, an IV beta- blocker

morphine

MODS stands for

multiple organ dysfunction syndrome

many women have been found to have atypical symptoms of MI, including

nausea indigestion palpation numbness

compensatory mechanism involved in HF that leads to inappropriate fluid retention and additional workload of the heart

neurohormonal response

Unstable Angina (UA)

new or changing chest pain caused by ischemia

do pacemaker cells contribute to contraction

no

characteristics of PVC

no P wave large and spread out QRS complex compensatory pause

third degree (complete) AV node block

no atrial activity is passed to ventricles ventricles are driven by Purkinje fibers

Schedule 1

no medival use

Long acting (Lantus)

no peak cannot be mixed

Bone Marrow Diseases

no platlets

do atria and ventricles contract at the same time

no ventricles follow 0.1 second later

is cerebral circulation influenced by sympathetic activity

no; regulated by intrinsic mechanisms

Clinical signs and sx of first degree AV block

none may progress into second or third degree AV block

unstable angina

not relieved by nitro

ACS NI

o2

82 yo man arrived to ED w/ sudden onset CP. other than 12 lead ECG, 1st, why? and 2nd?

o2 to decrease risk/ inj/ death bc adequate o2 is essential for organs/ tissues then OPQRST for onset/ palliative/ provocative quality (pain or pressure) radiation/ region severity timing

The patient with suspected MI should immediately receive

o2, aspirin, NTG, and morphine.

excessive daytime sleepiness insomnia and snoring

obstructive sleep apnea

occurs in men, especially those who are older and overweight

obstructive sleep apnea

Sputum specimen

obtain first thing in a.m. rinse mouth with H20 first

Compensated HF

occurs when compensatory mechanisms succeed in maintaining an adequate cardiac output that is needed for tissue perfusion

Decompensated HF

occurs when these mechanism can no longer maintain adequate cardiac output and inadequate tissue perfusion results ** now HF becomes symptomatic**

Q-wave changes with no change in the ST or T wave

old MI.

Always put IV K+

on a pump Never give IV Push!

when are the semilunar valves open? closed?

open during ventricular contraction close during relaxation (ventricular filling)

In the past, a step-wise approach starting with NSAIDs was standard of care. However, evidence clearly documenting the benefits of early DMARD (methotrexate [Rheumatrex], antimalarials, leflunomide [Arava], or sulfasalazine [Azulfidine]) treatment has changed national guidelines for management. Now it is recommended that treatment with the non-biologic DMARDs begin within 3 months of disease onset. Opioids are not indicated in early RA. Prednisone is used in unremitting RA

patient just diagnosed as being in the early stage of rheumatoid arthritis = methotrexate

PCI stands for

per cutaneous coronary intervention

PTCA

percutaneous transluminal coronary angioplasty

PTCA stands for

percutaneous transluminal coronary angioplasty (balloon angioplasty)

PTa segment can indicate

pericarditis or atrial MI if depressed

Complication of acute tonsillitis

peritonsilar abscess

pus causing one sided deviation of uvula

peritonsilar abscess

direct bacteria invasion of tissues of pharyngitis and peritonsilar space

peritonsillar abcess

occurs despite anbx therapy

peritonsillar abcess

possible indication of deviated uvula

peritonsillar abcess

possible indication of trismus

peritonsillar abcess

unilateral radiating pain to ear

peritonsillar abcess

A collection of pus on one of the tonsils.

peritonsillar abscess

causes tonic contraction of the muscles used for mastication

peritonsillar abscess

one sided unilateral pain radiating to ear, deviated uvula, trismus tx?

peritonsillar abscess aspiration risk, drainage penicillin or clinda, than

most common deep neck infection

peritonsillar abscess and or quinsy

chronic pharyngitis

persistent inflammation in pharynx

chronic pharyngitis

persistent inflammation of the pharynx. common in ppl who work in dusty surroundings, use their voice excessively, suffer from chronic cough, or habitually use alcohol and tabaco

fullness of soft palate (on either side of uvular) painful radiates to the ear drooling trismus, uvula deviation

pertonsillar abscess

highest rates in teens and young aduts

petitonsillar abscess quincy

soft palate petichia anterior cervical LAD

pharyngitis

can coexist together

pharyngitis and tonsillitis

arteriosclerosis

plaque buildup hardens arteries and diameter gets smaller

Lipids and fibrous tissue

plaque components

fibrous tissue development causes

plaque formation

T Lymphocytes and monocytes infiltrate lipids at arterial wall and die causing fibrous tissue. This causes

plaques

Fibrinogen

plasma protein converted to fibrin during clotting process

are proteins exchanged through capillaries

plasma proteins are not exchangeable proteins move via vesicular transport

Glycoprotein (GP) IIb/IIIa inhibitors target

platelet component of the thrombus = Abciximab (ReoPro), eptifibatide (Integrilin), tirofiban (Aggrastat) = may be given IV as it prevents fibrinogen attachment to activated platelets at thrombus site inhibiting platelet aggregation by PREVENTING FIBRIN BINDING PLATELETS

Point of maximal impulse (PMI)

point of apex that touches ACW where heart is easily observed and palpated

Etiology of Pulseless Electrical Activity

poor pumping action Massive MI Pulmonary embolism hypovolemia cardiac tamponade tension pnuemothorax ventricular rupture acidosis

Typical Angina Pectoris

post exertion. problem when the vessel is narrowed by more than 75%. caused by arthrosclerosis. Pain is limited or relieve by sublingual nitroglycerin. pain usually substrenal and may radiate down upper extremities.

If a pulse is absent in any ext. the cause may be

prior cath ext. chronic pvd, or a thromboembolic obstruction

Unstable Angina Pectoris

prolonged, worsening CP occuring w/o exertion, not relieved by rest or NTG

Etiology of Idioventricular rhythm

protective mechanism failure of normal conduction dying heart

Glucagon

protein hormone secreted by pancreatic endocrine cells that raises blood glucose levels; an antagonistic hormone to insulin.

Low Flow Oxygen Systems - Partial Rebreather Mask

provide O2 concentrations of 60-75% with flow rates of 6-11 L/min; mask has reservoir bag but no flaps; with each breath, pt rebreathes 1/3 of exhaled tidal volume which is high in O2 and provides a higher fraction of inspired air; be sure bag remains slightly inflated at end of inspiration

Low Flow Oxygen Systems - Non-Rebreather Mask

provides highest oxygen level of low-flow and can deliver O2 greater than 90% depending on pt breathing pattern; often used when resp status is unstable or who may require intubation; has one-way valve between mask and reservoir and 2 flaps over the exhalation ports; valve allows pt to draw all needed O2 from bag, flaps prevent room air for entering through exhalation ports (room air dilutes O2 concentration); air leaves exhalation ports while 1way valve keeps air from coming in

The patient with suspected MI should immediately receive supplemental oxygen, aspirin, nitroglycerin, and morphine. Morphine sulphate reduces preload and decreases workload of the heart, along with increased oxygen from oxygen therapy and bed rest. With decreased cardiac demand, this provides the best chance of decreasing cardiac damage. NSAIDs and beta-blockers are not normally indicated. Albuterol, which is a medication used to manage asthma and respiratory conditions, will increase the heart rate.

pt. suspected MI

what valves separate the ventricles and the arteries

pulmonary and aortic semilunar valves

PAOP

pulmonary artery occlusive pressure

PAWP

pulmonary artery wedge pressure is a measurement of pulmonary capillary pressure

right ventricle pumps deoxygenated blood to the

pulmonary artery, then to lungs

renin

released by kidneys in response to decreased blood volume; causes angiotensinogen to split & produce angiotensin I; lungs convert angiotensin I to angiotensin II; angiotensin II stimulates adrenal gland to release aldosterone & causes an increase in peripheral vasoconstriction

First action for chemical burn

remove client from chemical and flush for 15-20 mins

causes angiotensinogen to split & produce angiotensin I

renin

released by kidneys

renin

released by kidneys in response to decreased blood volume

renin

released in response to decreased blood volume

renin

when BP is returns to normal the body halts the release of

renin

RAAS

renin-angiotensin-aldosterone system

mitral valve repair or replacement,

requires CPB

opening of the chambers of the heart, for example, mitral valve repair or replacement,

requires CPB

Schedule 3

requires new prescription q6 months or 5 refills

Schedule 2

requires prescription

electrical defibrillation

resynchronizes heart by depolarizing all cells at the same time

what's the difference between the right and left ventricles

right ventricle pumps blood at a way lower pressure (12-14 mmHg) than the left ventricle (120 mmHg)

what are the AV valves

right: tricuspid (less pressure) left: bicuspid/mitral (stronger valve)

pre-capillary sphincters

rings of smooth muscle at the junction between arterioles and capillaries that dilate or constrict to control blood flow through the capillary bed

closure of mi and tri

s1

lub

s1

3 PVCs in a row

salvo

Clinical signs and symptoms of Junctional (escape) Rhythm

slow regular pulse often temporary if rate drops may experience sx of decreased CO

Clinical signs and Symptoms of bradycardia

seldom symptomatic. possible hypotension, dizziness, chest pain, or changes in LOC is markedly decreased

what makes the dub sound

semilunar valves closing (ventricles filling)

Suprasternal, supraclavicular are mild, moderate, or severe distress?

severe distress

With Oncology patients, REMEMBER

slight increase in temp= sepsis most important lab: absolute neutrophil count

Clinical signs and sx of second degree type II AV block

slow HR may produce signs of decrease cardiac output May progress to complete AV block or ventricular standstill(LETHAL)

clinical signs and sx of Idio ventricular rhythm

slow heart rate may have no pulse of BP decrease CO sycopal

Foods for K+

spinach fennel kale mustard greens brussel sprouts broccoli eggplants cantaloupe tomatoes parsley cucumber bell pepper apricots ginger root strawberries avocado bababa tuna halibut cauliflower kiwi oranges lima beans potatoes cabbage

Mg food sources

spinach mustard greens summer squash broccoli halibut turnip greens pumpkin seeds peppermint cucumber green beans celery kale sunflower seeds, sesame seeds, flax seeds

Type of cardiac chest pain that is a result of ischemia that is initiated by increased demand (activity) and relieved with the reduction of that demand (rest).

stable angina

30. A ____ provides structural support to a coronary artery following angioplasty to minimize the risk of stenosis.

stent

trach suctioning

sterile hyper oxygenate before and after stop advancing cath when you meet resistance or client coughs apply suction on the way out (intermittently) No longer than 10 seconds watch heart rate (when vagus nerve is stimulated HR drops)

BP returns to normal and the body halts the release of renin, which stops the RASS system.

stops the RASS system.

When a patient w/ angina, the patient is directed to stop all activities and sit or rest in bed in a semi-Fowlers position to reduce the oxygen requirements of the ischemic myocardium. Pursed-lip breathing and standing will not reduce workload to the same extent. No need to have the patient put his head between his legs because cerebral perfusion is not lacking.

stops; sits/ bed in semi fowlers reducing o2 demands of ischemic myocardium

baroreceptors

stretch receptors that monitor changes in blood pressure

37. A patient's cardiac output is determined by multiplying heart rate by _____ volume.

stroke

what happens to stroke volume as MAP increases

stroke volume decreases to compensate and return MAP back to normal

Ejection fraction

stroke volume/end diastolic volume 60%

ACS (acute coronary syndrome)

sudden symptoms of insufficient blood supply to the heart indicating unstable angina or acute myocardial infarction

atherectomy

surgical removal of arterial plaque buildup from an artery

angioplasty

surgical repair of a blood vessel(s) or a nonsurgical technique for treating diseased arteries by temporarily inflating a tiny balloon inside an artery

Native American cultural considerations

sustain eye contact refuse blood/organ donation may refuse circumcision may prefer care from tribal shaman rather than western medicine

common drugs used with burns

sutilanis or collagenase (eat dead tissue) sulver sulfaniazide (soothing, can lower WBC) Mafenide acetate (can cause acid/base problems) silver nitrate (keep dressings wet) povidone-iodine (stings, stains, allergies)

Tonsilectomy warning sign

swallowing repeatedly can signify bleeding

decreased EF and increased PAWD is the result of

systolic failure

Intrinsic Pathway

takes minutes to complete triggered by injury inside of vessel

TB (miliary)

tb spread non local to lung

Cardiac cycle produces output, which is?

the amount of blood the heart pumps in 1 minute

Afterload

the amount of resistance to ejection of blood from the ventricle

why is the lymphatic system necessary

the oncotic pressure from the plasma proteins is not enough to draw all the fluid back into the capillaries

Don't take rectal temp if

thrombocytopenic abdominoperineal resection immunosuppressed

Activity is generally begun as soon as possible

thromboembolism prophylaxis

continuous capillaries

tightly joined endothelial cells present in muscle, lungs, & adipose tissue

Epistaxis NI

tilt head forward while applying pressure to nose

TPA

tissue plasminogen activator

10. A patient scheduled for a cardiac stress test should be advised to avoid stimulants including ________ and caffeine prior to the examination.

tobacco

prolonged maintenance of tension in muscles of mastication

tonic contraction

fever of 104 exudates

tonsillitis

make sure airway is preserved!

tonsillitis

SIADH

too much ADH FVE Urine decreased and concentrated Blood diluted

T or F Nurses need to assess current respiratory status quickly, monitor progress and anticipate potential complications.

true

HHNK/ HHS

type 2 DM looks like DKA but no acidosis

Oxygen Delivery Systems

type of delivery system used depends on: oxygen concentration required by pt, oxygen concentration achieved by a delivery system, importance of accuracy and control of the oxygen concentration, patient comfort, expense to the patient, importance of humidity, patient mobility

Noninvasive Positive-Pressure Ventilation

uses positive pressure to keep alveoli open and improve gas exchange without the need for airway intubation; used to manage dyspnea, hypercarbia and acute exacerbations of COPD, cardiogenic pulmonary edema, and acute asthma attacks; mask must fit tightly or can lead to skin breakdown over bridge of nose; leaks can cause uncomfortable pressure around eyes; Types: CPAP

Clinical signs of accelerated juntional rhythm

usually benign

Clincal signs and sx of second degree type I AV Block

usually none if HR decreases may experience decrease Co sx USUALLY does not progress into higher degree block

Etiology of vfib

usually preceeded by PVC MI hypoxemia electrolyte disturbance electrical shock drugs(digitalis, catecholamines)

Angiotensin receptor blocker drugs

valsargan candesartan losartan telmisartan

as blood flows through the body, does flow rate or velocity change

velocity changes (slows down at capillary bed)

T wave =

ventricle repolarization Duration of *0.16 seconds*

what occurs during isovolumetric ventricular contraction

ventricles contract AV valves close Semilunar valves open

ST segment

ventricles contract and empty

TP interval

ventricles relax and fill

QRS complex

ventricular depolarization atrial repolarization <0.10 seconds

T wave

ventricular repolarization

closure of the mitral and tricuspid valves signal the beginning of

ventricular systole

what causes peripheral resistance

vessel diameter blood viscosity total vessel length

90% of all pharyngitis

viral

pearly white lesion of vocal cords

vocal nodule = cause of hoarseness

what is EDV

volume of blood in each ventricle at end of diastole (135 mL)

Preload

volume of blood in ventricles at end of diastole

cardiac output

volume of blood pumped per minute by each ventricle (5.25 L/min)