Angina & MI
T or F. A sign/symptom of unstable angina is pain and tightness around the neck, arm, jaw or chest.
A: True
Why does heart failure cause decreased cardiac output to the body?
We have a heavy fluid buildup in the heart that causes cardiovascular and pulmonary congestion. Makes it harder for body to pump out sufficient oxygen-rich blood to organs
Which type of stroke is often described as the “worst headache ever”, and clinically presents with the “classic” stroke signs and symptoms?
Hemorrhagic stroke
T or F. All spinal cord injuries are a result of ischemia.
true
T or F. One of the most common causes of a spinal cord injury is a motor vehicle accident
true
What medication am I? I can be given in the form of a pill or spray, often for the treatment for stable angina
A: nitroglycerin, aka “nitro”
Briefly describe why digoxin would be one possible medication used in the management of heart failure
digoxin causes an increase in intracellular sodium that will thus drive an influx of calcium into the heart and cause increased contractility. THUS increase effective contractions of the heart aids in removing the buildup of fluid in the heart and lungs.
T or F. It is safe to give fibrinolytics/thrombolytics for a patient with a hemorrhagic stroke.
False!
Define dysarthria.
difficulty forming words
Which of the following is a priority for a patient with ICP?
Monitoring respirations
Monitoring temperature
Administering morphine due to increased pain
Performing hourly blood pressures
answer: 1
Briefly explain what acute coronary syndrome (ACS) is
An emergent situation characterized by an acute onset of myocardial ischemia, that results in myocardial death. An acute change in plaque morphology and thrombosis - subtypes are unstable angina and MI
Name two key differences between left and right sided heart failure
LEFT = pulmonary congestion, dyspnea, orthopnea, cough, cyanosis, basilar crackles heard at base of lunds,
RIGHT = peripheral edema, increased JVD, anorexia, splenomegaly, ascites, hepatomegaly
Which of the following is an appropriate intervention for the management of a hemorrhagic stroke?
Promote stimulation so brain does not become inactive
Avoid administering analgesics even if the patient is in pain
Place patient on bedrest, with HOB elevated
Dim the lights, and leave on all beeping monitors
A: 3; bedrest = promotes rest and elevating the HOB helps to decreased pressure and swelling of the brain
What posture am I? The arms flex out to the side, and are ridgid and extended
decerebrate posture. This and decorticate posture is considered a LATE DEADLY SIGN of increased ICP!
Which of the following is NOT a cause of a dysrhythmia?
Unhealthy lifestyle
Increasing age
Electrolyte imbalances
Increased peripheral perfusion
Chamber stretch
answer: 4
Briefly describe what fibrinolytics/thrombolytics are. What is the latest from the onset of MI symptoms that they can be given?
“Clot busters” - help to dissolve clots. They are MOST effective if given up to 6 hours from the onset of MI symptoms; 12-24 hours later have some benefits, but not all.
Which if the following is NOT a treatment for heart failure?
Low-sodium diet and fluid restriction
Elevate the legs and HOB
Remove compression stockings every two days
Obtain daily weights on patient
Answer: 3
What is increased intracranial pressure? Name an early sign of increased intracranial pressure, and briefly describe why it occurs.
Increased intracranial pressure is caused by a brain injury or another medical condition that can cause growing pressure inside your skull. EARLIEST signs are altered LOC (restless, irritable) and decreased mental status. This occurs due to increased pressure placed on the brain and vessels, which reduces blood flow, and thus, oxygen to the brain
Which of the following is FALSE for multiple sclerosis (MS)?
The condition primarily impacts those over the age of 80
It is safe to participate in progressive resistance exercises
A patient with MS may require a speech therapist consult
MRI and CT scan can be used for diagnosis
Answer: a; mainly impacts young adults, esp women in their 20’s to 40’s
Which of the following is TRUE regarding administration of nitroglycerin?
Patient should sit before taking the medication
Only monitor temperature and blood pressure
If pain continues after 3 sublingual nitroglycerin tablets, you may administer a 4th
Store nitroglycerin in a warm room with enough moisture
answer: 1
For the treatment of a heart attack (MI), arrange the following in the correct order you would perform each intervention as the nurse:
a. Administer morphine
b. Give supplemental oxygen
c. Administer nitroglycerin
d. Administer aspirin
Answer: B, D, C, A
Supplemental oxygen administration - for perfusion
Administer aspirin - prevents increase clot size by interfering with platelet aggregation
Administer nitroglycerin - opens up coronary arteries
Administer morphine - helps to relax the heart and decrease workload
Which of the following is NOT a sign or symptom of heart failure?
Fatigue
Increased urine production
Confusion
Dysrhythmias
Both 2 and 3
answer: 2; we see a decreased urine production due to insufficient cardiac output, thus decreased renal perfusion = less urine output
Which of the following is FALSE for a transient ischemic attack (TIA)?
Symptoms usually last for 15 minutes or less
Blockage of a blood vessel in the brain
Caused by a microemboli that dissolves soon after
Considered to be a “warning sign” as it is temporary
Answer: 3; the microemboli are not destroyed, thus it can lodge elsewhere in the body
Levodopa/carbidopa is used to treat Parkinson’s Disease. Which of the following statements indicates that further patient education is needed?
“The medication has a slow onset of action”
“I should make slow position changes when on this medication”
“It is abnormal if I have red/brown urine, sweat and saliva”
“I should avoid eating high protein meals”
answer: 3
Which of the following is FALSE in spinal shocK?
Results in depressed cord function below the level of injury
Occurs 48 hours after injury
Temporary condition
None of the above
answer: 2; it happens immediately after injury!