HF
My my MI angina
CABG
Chest tubes
Pathogens are a Disaster
100
1. Which of the following statements are true?
A. HF can be cured if caught early enough.
B. HF can be attributed to a filling problem or a contracting problem.
C. Coronary artery disease is one of the main contributing factors for HF.
D. The heart muscle can repair itself if any blockage hindering blood flow to that area is cleared.
E. Cardiac output is the amount of blood ejected out of the atria each minute and is calculated by multiplying the HR by the stroke volume.
What is: 1. B,C
(No cure, the heart cannot repair itself but it can make collateral pathways to reroute blood around a blocked artery in the heart to avoid damage, cardiac output is measured by the ventricles not the atria)
100
*Refer to the heart image previously posted to answer the following questions (need to know the names of the coronary artery that goes with A,B,C,D,E - SATA):
1. Which coronary artery(ies) supply blood to the septum?
2. Which coronary artery(ies) would cause the most damage if blocked?
3. Which coronary artery(ies) supply blood to the right ventricle?
4. Which coronary artery(ies) supply blood to both the posterior left atrium and left ventricle?
5. Which coronary artery(ies) supply blood to both the right atrium and right ventricle?
What is: 1. C. right marginal artery (RMA), E. left anterior descending (LAD) 2. E. (LAD) 3. A. right coronary artery (RCA), C. right marginal artery (RMA), E. left anterior descending (LAD) 4. D. circumflex artery 5. A. right coronary artery (RCA)
100
Under which of the following circumstances might a Pt be a candidate for a CABG procedure? (SATA)
A. Uncontrolled HTN
B. It's a better option than a PCI d/t Pt preference
C. The Pt has a multivessel blockage
D. The LAD is stenosed more than 50%
What is: C and D
100
A patient who is post CABG is moved to the CICU for monitoring. The patient has four chest tubes and is on mechanical ventilation. The nurse understands it is important to assess the patency of the chest tubes Q4 hours to avoid which of the following complications?
A. Acute MI
B. Cardiac Tamponade
C. Pulmonary Embolus
D. Infection
What is: B
100
How would the following injured patients be triaged during a disaster? (Deceased, Immediate, Delayed)
A. Patient is breathing after airway opening
B. Patient is walking
C. Patient is walking and breathing after the airway was opened with a respiration rate of 33
D. Patient breathing is not restored after the airway was opened
E. The patient airway was restored with a respiration rate of 20, pulse of 127, and a capillary refill of more than 2 seconds
What is: A.Immediate, B.Delayed, C.Immediate, D.Deceased, E.Immediate
Resource: Triage tree on lecture slides
200
1. Which of the following describe or pertain to preload or afterload? Some may be a false statement. (name preload, afterload, or false as applicable)
A. End diastolic volume (EDV)
B. Hypervolemia
C. The left ventricle is measured as pulmonary vascular resistance
D. The force the ventricles must overcome to eject their blood volume.
E. The amount of cardiac muscle fiber tension, or stretch, that exists at the end of diastole, just before contraction of the ventricles.
F. Pressure is greatest in the pulmonary arteries.
What is: 1. A.preload, B.preload, C.false (pertains to afterload, but left ventricle is measured by systemic vascular resistance), D.afterload, E.preload, F. false (pertains to afterload, but arterial pressures are much higher than pulmonary pressures- which is one reason why the left ventricle has to work harder than the right)
200
Which of the three types of angina are being described below? (Answer: stable, prinzmental (variant), or unstable for each)
1. Most common
2. May last more than 20 minutes
3. Emergency
4. Non-emergent
5. Not associated with physical activity
6. Pain at rest or during activity
7. Coronary artery vasospasm
8. Cause could be altered calcium flow. Treat with diltiazem (calcium channel blockers).
9. Younger people
10. Relieved with rest and/or nitrates
What is: 1. stable 2. unstable 3. unstable 4. stable 5. prinzmental (variant) 6. unstable 7. prinzmental (variant) 8. prinzmental (variant) 9. prinzmental (variant) 10. stable
200
Which of the following statements about a CABG procedure are true? (SATA)
A. It's best to include the family when educating the Pt on what to expect.
B. The Pt should take a sleep aid the night before surgery.
C. It's best to withold the information about their chest being opened by cutting through the sternal bone.
D. An 18 gauge needle will be used for venipuncture the morning of surgery.
E. The goal is to remove the mechanical ventilator 48 hours post-op.
What is: A,B,D
200
The nurse is reviewing the doctor's notes about a Pt who will be admitted to the unit following a CABG procedure. The nurse reads, "The right internal mammary artery was harvested for the graft". The nurse anticipates the Pt will...
A. Require a longer healing time than if the saphenous vein was harvested.
B. Need an additional dose of propofol for enducing amnesia.
C. Require 2 chest tubes placed in the pleural space to draw out additional fluid and re-establish negative pressure.
D. Possibly need 4 chest tubes (2 in the mediastinum and 1-2 in the pleural space) to drain fluid and re-establish negative pressure.
What is: D
200
1. Which of the following patients would be considered a "transfer only" patient in the event of a disaster?
A. The patient who had a successful, firm bowel movement into a colostomy bag post sigmoid colostomy.
B. A patient who was extubated eight hours ago and has hoarseness and a respiration rate of 14, but is breathing on their own.
C. The patient admitted for nausea and vomiting over 24 hours, but has tolerated toast and lab values are now within limits.
D. A patient with atrial fibrillation that is beginning to respond to digoxin.
2. Using the same answer choices above, which would be considered a "first to go" so the hospital can make room for disaster victims?
What is: 1.B, 2.C
(answer A for question 2 could probably get outta here also assuming the stoma is a beefy red color and there's no sign of post-surgical infection)
300
1. Which of the following indicate the patient has systolic or diastolic heart failure? (name systolic or diastolic for each)
A. Hypertrophic cardiomyopathy
B. Increased preload
C. There is an increase in resistance to filling
D. Chronic hypertension
E. Weakening heart muscle gives less of a squeeze
F. Ejection fraction less than 40%
2. Which of the following indicates right sided or left sided heart failure? (name right or left for each)
A. Crackles
B. Cyanosis
C. Ascites
D. Propping up on pillows to sleep
E. Edema
F. Frothy/blood tinged sputum
G. Increased peripheral venous pressure
H. JVD
I. Liver enlargement
What is: 1. A. diastolic, B. systolic, C. diastolic, D. diastolic, E. systolic, F. systolic
2. A. left B. left C. right D. left E. right F. left G. right H. right I. right
300
A Pt reports to the ED with CP and is noticeably clutching his chest. Which of the following cardiac- focused questions should the nurse ask this patient? (SATA)
A. Where were you when the pain began?
B. What were you doing when the pain began?
C. Can you rate your pain on a pain scale of 0-10?
D. Does your family know you are here?
E. What does your pain feel like?
F. Where do you feel the pain?
G. How long has the pain lasted?
What is: B,C,E,F,G
(Slide 16)
300
Fill in the blanks:
1. A _____________ makes it so the surgeon can perform a bloodless operation.
2. The body temperature is _______ during the procedure to decrease metabolic rate and oxygen demand.
3. The IV cardioplegic solution is primarily made up of __________, which disrupts the sodium, potassium pump and stops the heart. Among other things, ________ is added to prevent metabolic acidosis.
4. If internal defibrillation is needed upon restoring cardiac functionality post-procedure, paddles are placed directly on the heart and _________ joules is delivered.
What is: 1. cardiopulmonary bypass machine 2. decreased (28-32 degrees C) 3. Potassium chloride, bicarbonate 4. 10-20
300
Some (T/F)
1. Sterile water is always used with drainage systems.
2. The bubbling in the suction chamber should resemble that of boiling water.
3. Drainage from the drainage system should be dumped out and counted as output as this Pt will have strict I's and O's
4. If the Pt's chest tube becomes disconnected, it should be reconnected immediately, even if sterility is compromised.
5. Bubbling in the water seal chamber should be gentle.
What is: 1.T 2.F 3.F (the unit will be completely changed, not dumped out. The other statement is correct) 4.T 5.F
300
Some (T/F) related to pathogens:
1. A pregnant nurse should avoid taking care of a pt with cytomegalovirus.
2. UV light is used to clean a room of a pt with VRSA (vancomycin-resistant staphylococcus aureus)
3. Staphylococcus aureus is problematic when it is on the pt's skin.
4. Ebola has latent symptoms averaging 8-10 days.
5. The nurse understands that hand gel is ineffective against VRE (vancomycin-resistant enterococci).
What is: 1.T, 2.F (extended spectrum beta-lactamase), 3.F (problematic when it enters a wound or the respiratory tract), 4.T, 5.F (hand gel is ineffective against clostridium difficile- C.Diff)
400
1. The nurse is caring for a Pt who was Dx with right-sided systolic dysfunction. Which of the following would the nurse expect to find in the pt's chart? (SATA)
A. Nursing assessment documentation noting crackles in the RLL (right lower lobe)
B. An order for a diuretic
C. An order to obtain I's and O's
D. An order for daily weights
E. An echocardiogram test result reveals hypertrophy of the right ventricle
F. A heart catheterization shows an ejection fraction of 34%
2. The nurse is reviewing medication orders on five patients with HF Dx. Which labs would the nurse closely monitor for each of the medications listed below?
A. enalapril
B. valsartan
C. furosemide along with lisinopril
D. spironolactone and losartan
E. digoxin
What is: 1. B,C,D,F 2. A. Na+ and K+ (ACE inhibitors block aldosterone- kidneys dump Na+ and keep K+ while also inhibiting RAAS resulting in vasodilation), B. Na+ and K+ (same action as ACE except ARBs block the receptor of angiotensin II rather than the conversion from angiotensin I to II) C. All e- (furosemide dumps all electrolytes and although ACE inhibitors retain K+, it's best to check all e-) D. All e-, but especially K+ (both retain potassium- risk for hyperkalemia) E. K+ and dig level (low K+ can lead to dig toxicity, dig level 0.5-2)
400
1. The nurse is reviewing labs at 1300 for a patient admitted to the ED with CP that radiates to the jaw. The Pt states the pain began at 1100. Which of the following labs would indicate potential damage to the myocardium?
A. Troponin I 0.7 mcg/mL
B. CK 37 mg/mL
C. CK-MB 8%
D. Troponin T 0.2 mcg/mL
An additional lab for...
A. Troponin I
B. Troponin T
C. CK-MB
D. CK
... was ordered for 1900. Answer the following questions about these labs: (SATA)
2. Which of these labs could have been present at 1500 (counting from the time pain began)?
3. Which of these labs give less detail about the cardiac muscle?
4. Which lab has a duration of 10-14 days?
5. Which lab is the golden standard when determining damage to the heart?
6. If a third set of labs is ordered in 6 hours at 0100, which labs would appear?
What is: 1.A (troponin I and T appear within 2-4 hours. Troponin I is outside of the parameters of 0.1-0.5 mcg/mL) 2.A,B,C,D (all labs Ck appears in 3-6h, CK-MB in 4-8h, Troponin T and I in 2-4h) 3.D 4.B 5.A 6. A,B,C,D (all labs- CK peaks 12-24h, CK-MB peaks 18-24h, Troponin I and T peak 24-36h)
(slide 25- use table from lecture ppt)
400
Complications of post CABG procedure:
1. The nurse understands electrolytes should be monitored d/t potential imbalances, specifically... (SATA)
A. Na+
B. Ca+
C. K+
D. Mg+
E. PO4
2. Both hemorrhage and pulmonary embolus are potential complications d/t the delicate balance of...
A. Heparin and Warfarin
B. Warfarin and vitamin K
C. Heparin and vitamin K
D. Warfarin and protamineE. Heparin and protamine
3. Renal function should be closely monitored d/t the sensitive nature of the kidneys. The nurse would assess the kidneys by... (SATA)
A. Percussion
B. Urinary output
C. Palpating
D. Labs- creatinine and BUN
What is: 1.B,C,D 2.E 3.B,D
400
Which of the following findings would be a concern for the nurse while caring for a Pt with a chest tube? (SATA)
A. Tidaling is present in the water seal chamber for a Pt with a closed pneumothorax.
B. There is an order to remove the chest tube, but the tube appears to be clamped instead.
C. The drainage color at 12 hours post-op is serosanguinous, then at 16 hours post-op the drainage color is bright red.
D. Upon assessment of the incision site there are small bumps present beneath the skin.
What is: C, D
400
The nurse may monitor the patient who is on day seven of an ATB regimen, clindamycin, for S&S of an infection caused by which of the following?
A. clostridium difficile
B. clindamycin-resistant enterococci
C. staphylococcus aureaus
D. extended spectrum beta-lactamase
What is: A - C.diff may reside in gut flora, use of ATB kills off good bacteria making conditions opportunistic for C.diff. Symptoms include- abdominal cramping, diarrhea, foul smelling stool, blood or pus in stool.
500
1. The nurse is caring for a Pt with HF and is experiencing atrial fibrillation d/t non-compliance with medication regimen. Which of the following medications is most appropriate for this patient?
A. atropine
B. epinephrine
C. lovenox
D. nitroglycerin
2. The nurse is caring for a Pt suspected of HF, which of the following tests would confirm this Dx? (SATA)
A. Telemetry monitoring
B. Echocariogram
C. Holter monitoring
D. Beta Natriuretic peptide (BNP) of 500
3. The nurse is caring for a patient with acute left ventricular systolic dysfunction, for which of the following medications ordered would the nurse intervene? (SATA)
A. digoxin
B. hydralazine
C. lisinopril
D. carvedilol
E. diltiazem
What is: 1.C (an anticoagulant would most likely be given while in a.fib to reduce the chance of a blood clot) 2. B,D 3. D,E (systolic is a contracting problem, beta-blockers slows heart contractions, calcium channel blockers slow the contractility)
500
Fill in the blanks: (word bank- some are not used :)
oxygen, ten, EKG, aspirin, non-stemi, NSAID, unstable, IV, five, morphine, stemi, nitroglycerin, two
A Pt arrives to the ED with CP for 3 hours that is unrelieved by rest. The Pt is cool to the touch with a HR of 91, RR of 23, BP 110/60, SPO2 92%, Temp 97.9 F. The nurse knows this is 1._______ angina and it is an emergency. The nurse assesses allergies to 2.______. If none, the nurse instructs the Pt to chew it up while delivering 3._______ to the Pt and establishing an 4._______. The Pt needs a(n) 5._______ stat for continued monitoring. The nurse instructs the Pt to take 6._______ SL and assess after 7.______ minutes, and repeating up to 8._______ additional times if pain is not relieved. 9.________ is given to assist in relieving pain by decreasing metabolic demand while also vasodilating. The nurse reviewing the EKG understands the Pt has a partial occlusion in a major coronary artery or possibly a complete occlusion in a minor coronary artery because the EKG reveals a(n) 10._________.
What is: 1. unstable 2. aspirin 3. oxygen (2L to start) 4. IV 5. EKG 6. Nitroglycerin (in hospital cases a nitro drip may be established rather than SL, I just listed it this way to quiz the lecture info) 7. five 8. two 9.Morphine 10.Non-STEMI (NSTEMI)
500
What's that med for patients who are Post-op CABG?
1. Used to increase heart contraction therefore increasing stroke volume and cardiac output, but monitor closely not to increase the heart rate too much because that will increase oxygen demand.
A. Amiodarone
B. Diltiazem
C. Epinephrine
D. Nitroglycerin (NTG)
2. A complication of CABG may be cardiac dysrhythmias, particularly A.fib, PVCs, and heart blocks. Which of the following med would be given for a Pt experiencing the complication, A.fib?
A. Propofol
B. Dopamine
C. Nipride
D. Diltiazem
3. A decrease in renal perfusion can be a complication of a Pt undergoing a CABG procedure, and it is important to monitor urinary output, BUN, and creatinine post-operatively. Which post-op medication works to increase renal artery perfusion when given in low doses?
A. Dopamine
B. Dobutamine
C. Amiodarone
D. Digoxin
4. This post-op medication increases heart contractility and cardiac output without increasing the Pt's heart rate. Sometimes a preferred medication.
A. Nipride
B. Epinephrine
C. Dobutamine
D. Amiodarone
5. A complication of CABG can be atrial or ventricular dysrhythmias. The Pt may be prescribed which med to help control this?
A. NGT
B. Amiodarone
C. Dobutamine
D. Diltiazem
What is: 1.C 2.D 3.A 4.C 5.B
500
1. What time is it?
What is: Time to go to bed
(my brain is tired of making up questions :) - best of luck to you all!!)
500
1. The nurse is caring for a patient with a MRSA infected wound of the LLE (left lower extremity). What precaution(s) would the nurse make to reduce nosocomial infections? (SATA)
A. Wear gloves while tending to the wound being sure to change gloves when advancing to another area of the body
B. Wash hands often
C. Initiate contact precautions
D. Bathe the patient BID
E. Initiate droplet precautions
2. In an effort to minimize resistance to ATB, which pieces of information are important to include in patient education regarding the use of ATB? (SATA)
A. Frequency
B. Mode of action
C. Dose
D. Discontinue when symptoms abate
E. Duration
What is: 1.A,B,C 2.A,C,E