Cardiac/Respiratory Practice Questions
What type of fluid is Albumin?
Hypertonic ("heavy")
What happens when a patient is not moving (from a psychosocial standpoint)?
Patient can get depression
What are the 2 types of blood pressures?
Peripheral & Central
What is PPN?
Peripheral Parenteral Nutrition (IV nutrition)- PPN is indicated when parenteral supplementation is required for 10 days or less. Because PPN is administered through a peripheral vein, the osmolarity of the solution is limited to 1150 mOsm/liter. PPN solutions contain 20% dextrose and must be supplemented with fat emulsions. Fat then becomes the major source of calories.
What electrolyte level is low if you have HYPO-active bowel sounds?
Potassium
What electrolytes are in the cell?
Potassium, Magnesium, Phosphorus K+illers, Murderers, and Pedophiles
What lab do you check with Coumadin (Warfarin)
Pt (Warfarin is less potent than Heparin)
What are of the brain is involved with fever (body temp)?
The Hypothalamus Memory trick: hypoTHalamus ....THermo
Most Myocardial Infarctions (MIs) are due to what?
Thrombus Formation
Antidote for Warfarin
Vitamin K memory trick: War Kills
How long does it take for sublingual Nitroglycerin to work?
Within 1-3 minutes
Is there any myocardial damage with a myocardial infarction?
Yes, there is permanent myocardial damage with myocardial infarction.
Elderly patients in the ICU may experience psychosis. The nurse knows that ICU psychosis may be exacerbated because of ______
a UTI Presents as confusion or delirium Nursing intervention: reality orientation,
What is CAD (coronary artery disease)?
a blood vessel disorder that is in the category of atherosclerosis (hardening of the artery) CAD is When fatty deposits form in the coronary arteries. Other names for CAD: Arteriosclerotic heart disease (ASHD), Cardiovascular heart disease (CVHD), Ischemic heart disease (IHD), Coronary heart Disease (CHD)
What type of IV fluid would the nurse give if the patient's BP is 220/120?
a hypotonic solution when the blood pressure is high- 0.45% Normal Saline
When do we worry about a temperature?
at 101 F If a patient has a temp of 100.5 F, we treat it as 101 F because we round 100.5 to 101. So, if a patient has a temp of 100.4 F, we would continue to monitor
In order to take a pulse ox, a _____ is needed
blood pressure (if you can't get a pulse ox, you can take the blood pressure--not the heart rate)
A desirable LDL level is dependent on what?
individual cardia risk factors
What is a patient at risk for when there is urinary stasis?
renal calculi, UTI (which leads to pyelonephritis, which leads to renal infection)
Myocardial infarctions often occur without a ________ event
without a precipitating event
What is the nursing goal for all hypertensive patients? What is the patient teaching?
The goal is to keep all patients normotensive. Patient teaching is to take meds for life as prescribed.
What is the difference between PPN and TPN?
The main difference between PPN and TPN is the route of delivery. PPN is delivered through a large-bore peripheral IV catheter; TPN requires a central venous catheter.
If malnourishment is suspected and the albumin levels are normal, what does this mean? What is the normal range of albumin levels?
The patient is NOT malnourished Normal albumin level: 3.5-5 g/dL (same as potassium)
What is TPN?
Total Parenteral Nutrition- TPN is indicated for the hypermetabolic, critically ill patient with bowel dysfunction. It is also indicated for the less severely ill patient if it is estimated that enteral intake will be delayed beyond 7 to 10 days. TPN solutions typically contain more concentrated glucose solutions, amino acids, and fat emulsions. A minimum of 2% to 4% of the total kilocalories should be administered as lipid to avoid essential fatty acid deficiency. The resultant hyperosmolar solution requires a central venous line for delivery. Complications of TPN include central line infections, hyperglycemia, and electrolyte disorders. To prevent the latter complication, daily adjustment of electrolytes in the solution may be required. Vitamins are added to the solution daily. Insulin may also be added to the solution to help control serum glucose levels.
For fractures, and other trauma, what type of IV fluid should be given?
Lactated Ringers (a plasma expander, an aggressive volume resuscitation from blood loss or burn injuries)
If a patient is not moving due to an oxygenation problem, what happens to the blood?
Venous Stasis Nursing Interventions: thromboembolitic stockings, low molecular heparin, check PTT
A meal tray arrives for a patient who is receiving 24% of oxygen via a Venturi mask. To maintain patient needs, the nurse should: a. Request an order for a nasal cannula during meals b. Discontinue the oxygen when the patient is eating c. Obtain an order to change the mask to a non-rebreather mask during meals d. Arrange for supplements that are liquid that can be administered with a straw
a. Request an order for a nasal cannula during meals
What are pack years in terms of smoking? Give an example.
(Packs x Year(s)) A nurse is collecting data about a patient's cigarettes' smoking habit. The patient admits to smoking 1.5 packs/day for the last 10 years. The nurse document that the patient has a smoking history of how many pack-years? 1.5 x 10 = 15 pack years
How much blood can someone lose before they go into a crisis?
10-15%
Antidote for Carbon Monoxide
100% O2
Normal INR range
0.8-1.2
How to calculate Heparin? A patient with Pulmonary Emboli was Ordered: 500 mL D5W with heparin 25,000 units IV to infuse at 1000 units/h. Calculate the flow rate. Flow rate: __________ ml/h FILL In Blank
20 Calculation: Total units (in IV bag) Units/hour -------------------------- = -------------- Total Volume (mL) x (mL/hr) cross multiply to get: total units (in IV bag)x (mL/hr) = Total volume x Units/hr 25000 units (x mL/hr) = 500,000 -------------------- ------- = 20 25000 25000
Ventricular Tachycardia (v-tach)
A life-threatening heart rhythm in which there is very rapid contraction of the ventricles, and the heart does not pump blood at all. Treatment: Amiodarone (anti-dysrhythmic)
For anything Atrial, give _____ (med)
ABCD's Adenosine (Adenocard--push in less than 8 sec) Beta-Blocker Calcium Channel blockers Digoxin
An HDL level of ____ is desireable
Above 40 mg dL
For anything Ventricular give ______ (med)
Amiodorone
How would you evaluate nausea?
Ask about it on a scale of 1-10. Ex: on a scale of 1-10, how nauseated are you on a scale of 1-10?
Atrial Fibrillation
Atrial quiver and can lead to the formation of thrombi. Think Decrease cardiac output: Lightheadness, palpitations, and shortness of breath. No definitive P-Wave Interventions: Give Oxygen especially if the patient is having Tachycardia Medication: Administer Coumadin (Warfarin) Sequential compression devices to lower extremities Continuous cardiac monitoring Assess changes in level of consciousness
Why would a patient having an MI become nauseated and vomit?
Because they are trying to get rid of unoxidized metabolites
What does Cardiac fatigue differ from Musculoskeletal fatigue?
Cardiac fatigue is related to activity (if you wash the dishes, you get tired; If you walk 20 feet you get tired) With Musculoskeletal fatigue, the patient can sleep all night and still wake up tired.
What is Ventricular Fibrillation (V-Fib)? What is the Treatment?
Chaotic rapid rhythm (chaotic squiggly line), ventricles quiver and is not cardia output and no pulse. No BP. No respirations and no heart sounds. Treatment: Defibrillate the client (for v-fib, you d-fib). Medication: Amiodarone (anti dysrhythmic) memory trick: amiodarone (5 syllables) defibrillator (5 syllables)
Whenever a patient is going home, you must use a _______
Checklist
The best indicator of the effectiveness of prednisone therapy in nephrotic syndrome is: a.Decrease in hematuria b.Increase in hematocrit C.Normal white blood cells d. Decrease in proteinuria
D. Decrease in proteinuria
What is the course of a fever after a procedure? In other words, what is the reason behind the fever on these days? Day 1-2, 2-4, 3-4, 4-7
Day 1-2: Atelectasis Day 2-4 UTI Day 3-4 Wound Infection Day 4-7 DVT
What is the action of morphine?
Decreases preload and afterload, decrease peripheral vascular resistance. In other words, it relaxes the blood vessels so the blood can move through the arteries and veins more easily.
Second line of treatment for high blood pressure?
Diuretics (ex: furosemide, spironolactone, hydrochlorothiazide) Monitor potassium levels
What is the first line of drugs used for a patient with hypertension?
Diuretics -- Where salt goes, water goes. Control salt/water = control of BP
What types of people cannot handle abrupt vital sign changes?
Elderly people
Another name for cardio myopathy is _______
End stage cardiac disease (nothing else can be done)
Dopamine - when to give high dose and when to give low dose?
For urine output, give low dose Blood BP, give high dose. 1-2 mcg/kg
Antidote for Beta-Blockers
Glucagon memory trick: BB Gon
When potassium is low, magnesium is _____.
Low; When one is low, the other is usually low
If a peripheral BP is 80/40, what is the internal BP? Higher or lower
Lower
Normal INR NOT on Warfarin Normal INR range on warfarin
Not on Warfarin: <1 On Warfarin: 2.0-3.0 if above skip day or two of warfarin or Vitamin K if INR is above 4.5
How will the nurse document the pack-year smoking history for a client who reports smok-ing a pack of cigarettes a day for 10 years, quit-ting for 4 years, and then smoking 2 packs a day for the last 25 years?
Pack-years are calculated by multiplying the number of packs smoked per day by the num-ber of years of smoking at that rate. One pack per day X 10 years = 10 pack-years, plus 2 packs per day X 25 years = 50 years. Total is 50 plus 10 for 60 pack-years.
Antidote for Anticholinergic Drugs
Physostigmine (a benzodiazepine)
What happens when there is too much fluid in the liver?
Portal Hypertension
What is the purpose of an intra aortic balloon pump?
Provides temporary circulatory assistance to the sick heart by reducing afterload. This results in improved coronary blood flow. Inflates at the start of diastole and deflates just before the next systole.
If a patient has a blood clot, administer ______ within 4 hours.
TPA within 4 hours
Prednisone treats ________ and cures ________
Treats everything and cures nothing
Asystole
flat line, complete lack of electrical activity in the heart Treatment: give Epinephrine and Atropine
With acute coronary syndrome, there is an imbalance between _____, ______, and ______.
oxygen, supply, and demand So, we want to greet the patient with "Nurse MONA" (but not in that order. It would be AONM
Which is the priority medical-surgical concept when the nurse is assessing a patient with cardiovascular disease (CVD)? perfusion acid-base balance gas exchange fluid and electrolytes
perfusion
Episodes of angina are commonly associated with a ___________event.
precipitating event (ex: physical or emotional stress)
What is the purpose of cardioversion? When to cardiovert?
to slow down the heart when it is in a tachycardic state by using electricity. When to cardiovert: it patient is suffering some type of unstable tachycardia or when medication therapy and/or vagal maneuvers do not work.
With age, the heart becomes _________
with age, the heart becomes weaker
Treatment for MI, CHF and Pulmonary Edema, UNLOAD FAST. What is unload fast?
● U - Upright position ● N - Nitro ● L - Lasix ● O - Oxygen ● A - Aminophylline (Levels = 10 - 20) ● D - Digoxin (Levels = 0.5 - 2.0) ● . ● F - Fluid restriction (2L) ● A - Afterload, decrease ● S - Sodium, decrease (2g) ● T - Tests (CKMB, ECG, Troponin, Digoxin, Potassium)
What type of risk do people with diabetes have for cardiovascular disease?
Diabetics are 2-3 times the risk of cardiovascular disease because diabetes accelerates the atherosclerotic process.
How long does a gastrointestinal cell live
1 day
How long can a patient stay on IV fluids (for nutrition)? What comes after?
1-2 days (clear liquid diet--NS or D5W --These are considered hydration, NOT nutrition) After that, the patient will be on PPN After that, the patient will be on TPN
Nursing Interventions: turn, cough, deep breathing, incentive spirometer (for patient)
10 times/hour while awake
When giving Albumin, what is the ratio in which the blood volume is increased?
1:1 Example: If you give 500 mL of Albumin, it will increase the blood volume by 500 mL
What time are vital signs the lowest?
1am - 5am
How does the crystalloids: Normal Saline (NS), Lactated Ringers (LR), and 5% Dextrose in water (D5W) affects the blood volume in terms of ratio?
3:1 Example: If there is a GSW that comes into ER, there may be 3-4 sites of IV access. The 3:1 ratio means that 3 parts of the solution goes to the interstitial space, and 1 part of the solution stays intravascular. So, it there is a Liter bag of (insert crystalloid), 750 mL goes interstitial (this will make the patient swollen), and 250 mL stays intravascular.
First line of treatment for high blood pressure?
Diet/Lifestyle changes
Acute Coronary Syndrome is a term that can also be used to describe ____.
A heart attack (MI)
Antidote for Digoxin
Digibind or DigiFab
How often does the nurse perform AccuChecks for a patient with diabetes?
AC/HS: Before meals and at bedtime = 4 times/day
4th line of treatment for high BP?
Ace Inhibitors They inhibit the conversion of angiotensin I to II. In other words: ACE inhibitors prevent an enzyme in the body from making angiotensin 2, a substance that narrows blood vessels. This narrowing can cause high blood pressure and forces the heart to work harder.
How does Albumin affect blood volume?
Albumin, the main protein produced in the liver, has numerous functions in the body, the most important of which is maintaining intravascular COLLOID osmotic pressure (COP). COP helps fluid stay within the vasculature instead of leaking into tissue.
What is the pathophysiology of a myocardial infarction?
An MI is the necrosis of the myocardial tissue resulting from total disruption of the blood supply of the heart. With MI, there is an area that is dead (necrosis), an area that may be saved (injury), and an area that probably can be saved (ischemia).
What is a major concern with administering a protein such as Albumin?
Anaphylaxis - The condition of abnormal sensitiveness produced in an animal or human by the injection of a foreign protein — the phenomenon now commonly designated as anaphylaxis or allergy — is believed to exhibit a high degree of specificity with respect to the substances used to provoke a response.
With CAD, an ______ can identify which areas of the heart are blocked
Angiogram -a scan that shows blood flow through arteries or veins, or through the heart using x-rays, CT Scans, or MRIs -Furthermore, an angiogram (cardiac catheterization) is the Gold Standard for identifying the location and the severity or the blockages of the coronary artery.
What are ways to prevent foot drop in a patient?
Apply tennis shoes or use foot board
Arterio vs Atherosclerosis
Arterio = thickening/hardening of arterial walls Athero = plaque build-up on the arterial walls
How can medical staff ally for patients considering the stressful nature of ICU/CCU
Assign the same nurse when possible
What is a patient at risk for if they are not moving (from a musculoskeletal standpoint)?
Atrophy, Contractures
Third line of treatment for high blood pressure?
Beta-Blockers (-lol) Works by inhibiting the beta adrenergic response and slows down the heart rate Teach patient to monitor their heart rate
CRP vs ESR
Both inflammatory markers... CRP measures the level of ONE specific protein. ESR-takes account of many proteins
What would a patient be on a regular diet?
Because it contains the basic food groups (protein, fruits, vegetables, and grains
A triglyceride level below ______ is desirable
Below 150
5th line of treatment for high blood pressure?
Calcium Channel Blockers They work by inhibiting the influx of calcium across the cell membrane. They block entry of calcium into vascular smooth muscle and myocardial cells, preventing contraction/constriction. In other words, They stop calcium from entering the cells of the heart and arteries. Calcium causes the heart and arteries to squeeze more strongly. By blocking calcium, calcium channel blockers allow blood vessels to relax and open.
What type of study would the doctor perform if the patient has High Systolic Blood Pressure (140 mmHg or higher)
Cardiac studies
Which BP is more accurate: Peripheral BP or Central BP?
Central BP
A person with a cholesterol problem or CAD may have an elevated _____ level
CRP (inflammatory marker)
Sequence of events that go from chest pain and lead all the way to cardiogenic shock
Chest Pain -> Myocardial infarction -> CHF -> Cardiogenic Shock
Anything greater than ______ cannot go into a peripheral (nutrition) line.
D10W because anything greater than D10 can stripe the peripheral vein(s) D10 is a hypertonic solution. Dextrose 10% in Water (D10W) is an hypertonic IV solution used in the treatment of ketosis of starvation and provides calories (380 kcal/L), free water, and no electrolytes. It should be administered using a central line if possible and should not be infused using the same line as blood products as it can cause RBC hemolysis.
When the patient ask the nurse about the best method to diagnose heart failure, what teaching would the nurse provide X-Ray cardiac isoenzymes and T troponin Correct Answer Echocardiography MUGA scan CT scans
ECG
What is the best method to diagnose heart failure?
Echocardiography (ECG)
Rule of thumb when monitoring vital signs and checking the site when a patient return from a procedure (ex: cardiac catheterization), or post-surgery?
Every 15 minutes X 4 then Every 30 minutes X 4 then Every 1 hour X 4 then Every 4 hours
Activity intolerance vs Fatigue
Fatigue is considered normal because we can all have it from time to time. (H & H is normal) Activity intolerance, the H & H is low
What is the patient at risk for if there is respiratory stasis?
First: Pneumonia After that: Respiratory Failure
What is the patient at risk for when there is venous stasis?
First: Thrombi After that: Emboli
Antidote for benzodiAZEpines
FlumAZEnil
What is the overall goal for a patient in cardiogenic shock? What is the drug of choice? Treatment of choice?
Goal: to restore heart function and the balance between O2 supply and demand in the myocardium. Drugs of choice to decrease the workload of the heart by: -dilating the arteries -> nitrates -reducing preload -> diuretics -afterload ->vasodiloators -heart rate and contractility ->beta blockers Treatment: patient may benefit from a n intraaortic balloon pump, ventricular assist device (VAD)
Good cholesterol Bad cholesterol
HDL LDL
Normal Hematocrit and Hemoglobin levels
Hct (hematocrit) Females: 37-47% Males: 42-52% Hb (hemoglobin) Females: 12-16 g/dL Males: 14-18 g/dL
What are the 4 determinants of Cardiac Output
Heart rate Preload Afterload Contractility
How do you know when to back off of IV fluids
Increased BP; At this point, the patient will be edematous (swollen), so the nurse would give a diuretic such as Lasix (furosemide)
Inflammation vs Infection
Inflammation is a response to tissue injury Infection is tissue invasion by microorganisms. Overall, an inflammatory reaction will be provoked when infection occurs in an otherwise healthy patient.
What is another name for Hypovolemic Shock
Intravascular Shock or hemorrhagic shock
Whenever there is an isotonic fluid loss (vomiting), you must replace it with what type of IV fluids?
Isotonic IV fluids: 0.9% NS, Lactated Ringers, D5W
Antidote for Potassium
Kayexalate or "Big K": Bicarb, Insulin, Glucose, Kayexalate
What type of MI is the worst?
Left Anterior MI's are the worst. More specifically, the anterior ST-segment elevation myocardial infarction (STEMI), also known as the widowmaker. The size determines more damage, if it's a small MI, then will see small damage. Anterior may see crackles and dyspnea. May go into left sided heart failure and you may see: dyspnea, crackles, right upper quadrant pain and oliguria. IF develop pulmonary edema, will see coarse crackles and tachycardia
What kind of blood pressure is taken in the periphery? (Peripheral BP)
Mean (average) BP
Antidote for Opiods Ex: oxycodone, codeine, hydromorphone, methadone, fentanyl, oxymorphone, morphine, hydromorphone, tramadol
Narcan
Does Heparin dissolve clots?
No, it slows down the formation of clots
Can ARBs be used with beta blockers?
No; BB with angiotensin converting enzyme inhibitors/angiotensin receptor blockers (ACEI/ARBs) is not an ideal combination as both the drugs act in the renin-angiotensin system. ARBs are anti-beta blocker
A low-grade fever normal or abnormal with heart attack?
Normal because of inflammation. Whenever there is tissue injury, there is inflammation.
Antidote for Heparin
PROtamine Sulfate memory trick: Proton = H+ H+ for Heparin
What lab do you check with Heparin?
PTT Heparin is more potent than Warfarin)
If a patient's hemoglobin saturation via pulse oximetry indicates inadequate O2. What should the nurse do?
Raise the head of the bed (high or semi-fowlers) This promotes effective chest expansion and diaphragmatic descent.
What type of study would the doctor perform if the patient has high diastolic blood pressure (90 mmHg or higher)
Renal studies
How to administer sublingual nitroglycerin
SL NTG tablets or translingual spray (Nitrolingual) usually relieves pain in about 5 minutes and lasts about 30 to 40 minutes. The recommended dose of NTG is 1 tablet taken sublingually (SL) under the tongue for symptoms of angina. If symptoms are unchanged or worse after 5 minutes, the patient should repeat NTG every 5 minutes for a maximum of 3 doses. Teach the patient to contact the emergency response system (e.g., 911) if symptoms have not resolved completely after 3 doses. Teach the patient the proper storage and use of NTG. It should be always easily accessible to the patient. Store the tablets away from light and heat sources, including body heat, to protect them from degradation. Tablets are packaged in light-resistant bottles with metal caps. Once opened, the tablets lose potency. They should be replaced every 6 months.
What type of shock is the ONLY shock that involves a fever
Septic Shock
Which drug is the first line of therapy against an acute episode of angina?
Short-acting nitrates are first-line therapy for an acute episode of angina. Nitrates produce their principal effects by the following mechanisms: Dilating peripheral blood vessels: This results in decreased SVR, venous pooling, and decreased venous blood return to the heart (preload). Therefore myocardial O2 demand is decreased because of the reduced cardiac workload. Dilating coronary arteries and collateral vessels: This may increase blood flow to the ischemic areas of the heart. However, when the coronary arteries are severely atherosclerotic, coronary dilation is hard to achieve.
Which modifiable risk factor for CAD (coronary heart disease) contributes to the greatest extent?
Smoking (2 major risk factors to teach the patient is smoking cessation AND diet therapy (low cholesterol))
Types of Angina (chest pain)
Stable Angina Prinzmetal's Angina Unstable Angina Nocturnal Angina
What type of blood do you give if you do not know the blood type?
Type O
