Anatomy and Conduction
What is the pacemaker of the heart that initiates the heartbeat?
SA node, it sets the rhythm (60-100 normal)
Heart failure.
Left-sided heart failure primarily affects what?
The lungs. Blood backs up into the lungs and causes congestion, you will hear crackles.
What is the therapeutic range for digoxin?
0.5-2 ng/mL, greater than 2 is toxicity, patient will have bradycardia and may see halos. Toxicity risk is also increased if a patient is on a loop diuretic.
What should the nurse do first if a patient develops chest pain unrelieved by nitroglycerin?
Apply oxygen! ABCs, oxygenation is always the top priority. Also remember MONA, it is NOT in that order! Oxygen first.
Tell me the electrical conduction pathway in the heart
SA node, AV node, bundle of His, right/left bundle branches, Purkinje fibers
Which lab confirms a myocardial infarction?
Elevated troponin, rises within 3 hours and is specific to cardiac muscle
Right-sided heart failure leads to what physical finding?
Peripheral edema and jugular vein distension (JVD), blood is backing up in the venous system.
Which electrolyte must be monitored with furosemide administration?
potassium
A patient gains 3 lbs in 2 days and has shortness of breath? What is the priority action?
Assess for worsening heart failure, notify MD
The AV node's primary function is to
Delay conduction to allow ventricular filling, this prevents the ventricles from contracting before they are fully filled.
BNP of 900 indicates what?
Severe heart failure, the BNP increases as the ventricles stretch from excess volume.
A client reports chest pain that is relieved by rest and nitroglycerin. What condition does this suggest?
Stable angina, pain is usually caused by exertion and relieved by rest.
Which side effect of lisinopril should be reported immediately?
What should the nurse do before administering a beta blocker?
Check apical pulse for a full minute and hold if less than 60.
Which wave on the ECG represents ventricular depolarization?
The QRS complex shows ventricular contraction, the P wave shows arterial contraction
ST-segment elevation on an ECG suggest?
Myocardial infarction, this is a STEMI (ST elevation Myocardial Infarction)
Unrelieved chest pain after nitroglycerin and rest may indicate?
What is the antidote for warfarin toxicity?
Vitamin K, patient should AVOID leafy green vegetables and other K rich foods.
A patient on heparin has an aPTT of 110 seconds. What is the appropriate nursing action?
Hold the dose and notify the provider.
What is the intrinsic rate of the ventricles if the SA and AV nodes fail?
20-40, the Purkinje fibers take over, this is immediately life-threatening.
What is the normal ejection fraction range (EF)?
55-70%, less than 40 is heart failure that causes decreased cardiac output.
A client with PAD (peripheral arterial disease) should position their legs how?
Down to promote blood flow to the extremities.
Avoid potassium-rich foods, spironolactone is potassium-sparing
A patient develops new crackles after an MI. What is the nurse's priority?