NAME THAT ECG!
(And what to do with it)
(And what to do with it)
Need to Know Meds
Life in Pre/Post-Op
Important Heart Interventions/Complication
Random Trivia
100
Your patient's ECG shows this strip. They do not have a pulse, what is your next step?
DEFIBRILATE!!!!
100
What's the medication you can give to someone to reduce their blood pressure that WILL NOT lower heart rate?
Milrinone (Primacor)
100
A patient is in pre-op and is preparing to go in for a CABG. What are some things you need to educate him on before his surgery?
-How much pain he will be in afterward.
-All the tubes and wires he will be connected to. (Ventilator, chest tubes, ECG, VS machine, etc.)
100
Name 3 Signs/Symptoms for each disorder listed:
1) Thoracic Aortic Aneurysm
2) Abdominal Aortic Aneurysm
3) Aortic Dissection
1) TAA
1. Hoarseness
2. Dysphagia
3. Dyspnea
2) AAA
1. Abdominal/Back Pain
2. Bruits in abdominal assessment
3. Mass in abdomen (DON'T PALPATE)
3) Aortic Dissection
1. Sudden/Intense chest pain (ripping/tearing)
2. Widened mediastinum on CXR
3. Severe hypertension
100
While doing CPR on a patient, their family comes in. Their family starts asking questions about what is going on. The Charge Nurse tells everyone to ignore them and continue resuscitation measures. Was this correct practice?
No, the family is entitled to information regarding the resuscitation measures on their family member.
200
What symptoms would you expect the patient to be experiencing with this kind of rhythm?
Hyperactive deep tendon reflexes, palpitations, N/V, fatigue, and muscle weakness.
200
A new grad nurse gives her patient Nesiritide for heart failure. The patient's blood pressure begins to drop. The new grad nurse freaks out and calls for help. The charge nurse explains that the patient is fine and the new grad needs to calm down. Why would the charge nurse say this?
Nesiritide is a vasodilator and decreased BP is a expected side effect.
200
During the first hour post-op following a CABG, how much drainage should the nurse expect in the chest tube?
150-200 mL/hr
200
A patient's coronary artery has a 52% narrowing. Can she undergo percutaneous coronary intervention (PCI)?
No, because the coronary artery must have atleast a 70% narrowing.
200
Name all the H's and T's associated with reversible causes of cardiac arrest.
H's T's
-Hypoxia -Trauma
-Hydrogen Ions (Acidosis). -Thrombosis (Coronary or Pulmonary)
-Hypovolemia -Tamponade
-Hyper/Hypokalemia -Toxins
-Hypoglycemia -Tension Pneumothorax
-Hypothermia
300
You have a patient who has an HR of 40 bpm with a BP of 82/40. The patient is also experiencing some episodes of syncope and has pale, cool skin. What is the patient experiencing?
Bonus for 5: What can you give to improve his symptoms?
Symptomatic Bradycardia
Bonus: Atropine
300
What is the expected physiological effect following administration of a positive inotrope?
Increased myocardial contractility and cardiac output
300
How do you differentiate angina pain from incisional pain in a post-op patient after cardiovascular surgery?
Incisional pain occurs right where the surgical site is, and angina can radiate to the next and arms.
300
When the IABP is working correctly, what does it do to the myocardial oxygen demand and the afterload?
Myocardial oxygen demand decreases, and afterload is reduced.
300
Your patient has a pacemaker that shows pacing spikes; however, there is none found after the QRS complex. What is this called?
Failure to capture
400
Telemetry calls the nurse and tells her that her patient in Room 2's monitor shows a flatline. What should the nurse do next?
A) Panic
B) Call the provider
C) Run in the room and begin CPR
D) Go into the room and assess the patient
D) Go into the room and assess the patient
400
Which medication is used to prevent graft closure after a CABG?
Bonus for 10: What class is this medication, and why does this class work for this situation?
Aspirin
Bonus: Aspirin is a platelet inhibitor. This will prevent thrombi from forming and arterial vasoconstriction, which means the graft won't close.
400
A patient is 3 hours post-op in the ICU. Upon checking her hemodynamics, you realize that her SVR is elevated and her BP is 140/106. What is this patient experiencing and how can you help her?
The patient has reduced afterload and needs nitroprusside.
400
Your patient is on an IABP. What are some signs and symptoms that need to be brought to the provider's attention IMMEDIATELY?
-Decreased urine output as a result of poor perfusion
-Blood in the foley bag
-Pulses that cannot be found even with a Doppler.
400
You have a patient who is 3 hours post op following a carotid endarterectomy. On your previous assessment, the patient was alert and oriented x4. During your next assessment, the patient seems to be delirious, confused about where he is, and is trying to rip out his IV. What should the nurse do first?
A) Call the provider/surgeon
B) Put him on restraints
C) Immediate neuro assessment
D) Check the patient's BP
Immediate neuro assessment
500
A 58-year-old with a history of heart failure has been admitted to the ICU and has been hooked up to the monitor.
Rhythm strip findings:
-Rate: 120 bpm
-Rhythm: Irregularly irregular
-No identifiable P waves
-Narrow QRS
Assessment Shows:
-BP: 132/80
-No chest pain
-Mild Fatigue
What is this rhythm?
Bonus for 10: What is a major risk if this is left untreated.
Atrial Fibrillation with RVR
Risk: Stroke
500
A patient who has had atrial fibrillation for 72 hours is scheduled for an electrical cardioversion. The nurse questions if he has been given anticoagulation drugs and whether a transesophageal echocardiogram has ruled out an atrial thrombus.
Why would the nurse want to confirm that there are no atrial clots before cardioversion?
Cardioversion can dislodge the atrial thrombus and cause a stroke.
500
If a patient has a stent placed, what will happen if the BP is too high or too low? (Tell me what will happen in both cases)
If the BP is too high, the stent will rupture.
If the BP is too low, the stent will collapse.
(Think of it like a bridge)
500
You are caring for a client in the ICU who is 2 hours post-op following a CABG surgery. During the last hour, you noticed that his chest tube drainage has decreased from 170 mL/hr to 25 mL/hr. The clients BP has also decreased from 118/72 mmHg to 84/50 mmHg. The client's CVP has increased from 8 mmHg to 18 mmHg over 30 minutes and then suddenly decreased to 10mmHg. What is this patient experiencing?
Bonus for 10 pts: What should the nurse do next?
Cardiac Tamponade
Bonus: The nurse should immediately contact the provider/surgeon and prepare to strip the chest tube.
500
The nurse has just finished setting up the patient's epinephrine drip. What other drip will the nurse need to set up for this patient?
A) Fluid Bolus
B) Dobutamine
C) Insulin
D) No additional drip needed
C) Insulin