ECG Interpretation
Cardiac Medications
Potpouri
Medications
CHF
I/O
MI
Name Three
Hodge Podge
Pain
100
Describe the P wave in a junctional rhythm.
the P wave is either inverted or absent.
100
A nurse is teaching a client who has a new prescription for digoxin. Which of the following instructions should the nurse include in the teaching?
- "Report changes in sight."
- "Avoid foods high in potassium."
- "Take the prescribed second dose at nighttime."
- "Limit your fluid intake to no more than 1.5 L a day."
"Report changes in sight."
Patients have reported seeing yellow halos with digoxin toxicity.
100
A nurse is caring for a client who has a prescription for potassium chloride (KCL) 20 mEq PO daily. The nurse reviews the client's most recent laboratory results and finds the client's potassium level is 5.2 mEq/L. Which of the following actions should the nurse take?
- Give the ordered KCL as prescribed.
- Omit the KCL dose and document it was not given.
- Call the prescribing physician and inform her of the client's serum potassium level results.
- Call the lab to verify the client's results.
Call the prescribing physician and inform her of the client's serum potassium level results.
100
What is the classification of cardiac drugs that end in "LOL"
Beta Blockers
The medicines block the effects of the hormone epinephrine, also known as adrenaline. Beta blockers cause the heart to beat more slowly and with less force.
100
A patient with a recent diagnosis of heart failure has been prescribed furosemide (Lasix) in an effort to physiologically do what for the patient?
A. Reduce preload.
B. Decrease afterload.
C. Increase contractility.
D. Promote vasodilation.
A. Reduce Preload
100
Calculate the fluid input for the patient:
Coffee 8 ounces
1/2 cup orange juice
100 ml free fluid bolus
I cup of ice chips
IV antibiotic at 75ml/hour for 4 hours
240+120+120+100+300
880 ml
ice chips are calculated as 240/2 (1/2 fluid;1/2 air)
100
The nurse is caring for a patient who complains of chest pain. What blood test would be included specifically to determine heart muscle damage?
Troponin
Troponin is a protein in the muscle of the heart and would not normally be in the bloodstream unless the cardiac tissue is damaged.
100
Name three types of premature ECG complexes/beats.
PAC- Premature Atrial Complex
PJC- Premature Junctional Complex
PVC- Premature Ventricular Complex
100
what does the Pneumonic PQRST stand for when assessing pain
precipitating factors
quality of pain
region and radiation
severity
timing
100
A nurse is preparing a client for surgery. Prior to administering the prescribed hydroxyzine, the nurse should explain to the client that the medication is for which of the following indications? (Select all that apply.)
- Controlling emesis
- Diminishing anxiety
- Reducing the amount of narcotics needed for pain relief
- Preventing thrombus formation
- Drying secretions
Controlling emesis
Diminishing anxiety
Reducing the amount of narcotics needed for pain relief
Drying secretions
200
Your patient is in the following rhythm. The patient is alert, oriented, anxious. Vagal maneuvers did not change the rhythm. What should the nurse anticipate for immediate intervention.
Administer 6mg Adenosine IV push to chemically convert the rhythm. Given very fast and as close to the heart as possible.
200
A nurse is caring for a client who has congestive heart failure and is taking digoxin daily. The client refused breakfast and is complaining of nausea and weakness. Which of the following actions should the nurse take first?
- Check the client's vital signs.
- Request a dietitian consult.
- Suggest that the client rests before eating the meal.
- Request an order for an antiemetic.
Check the client's vital signs.
200
The nurse is preparing insulin for a client and observes the date of expiration on the vial occurred 2 days ago. Which of the following actions should the nurse take?
- Administer the medication.
- Discard the medication in the sharps container.
- Notify the provider.
- Return the medication to the pharmacy.
Return the medication to the pharmacy.
The pharmacy will document the medication amount and dispose of the medication properly.
200
What is the classification of cardiac medication that ends in "il"
ACE inhibitors
Angiotensin-converting-enzyme inhibitors are a class of medication used primarily for the treatment of high blood pressure and heart failure. They work by causing relaxation of blood vessels as well as a decrease in blood volume, which leads to lower blood pressure and decreased oxygen demand from the heart
200
A patient with chronic heart failure has ankle edema, a 2-kg weight gain over the past 2 days and complains of "feeling too tired to get out of bed." Based on these data, what would be your nursing diagnosis.
activity intolerance related to fatigue.
fluid overload r/t increased volume
200
What is the best indicator in the nurse's assessment of perfusion status?
Urine output
200
the percent of end-diastolic volume ejected with each heartbeat.
What is ejection fraction (EF)?
200
Name three types of tachycardia
sinus tachycardia
junctional tachycardia
atrial tachycardia
supraventricular tachycardia
idioventricular tachycardia
200
A patient presents with profuse bleeding from the head after being in a motor vehicle crash. The patient is confused;O2 saturation is 82%, B/P is 80/30, pulse is 140, Respirations are 26. The nurse suspects the patient is showing signs of what?
Hypovolemic shock
200
A hospice nurse is caring for a client who has terminal cancer and takes PO morphine for pain relief. The client reports that he had to increase the dose of morphine this week to obtain pain relief. Which of the following scenarios should the nurse document as the explanation for this situation?
- The client not been taking the medication properly.
- The client is experiencing episodes of confusion.
- The client has become addicted to the medication.
- The client developed a tolerance to the medication.
The client developed a tolerance to the medication.
300
A patient is in Ventricular Tachycardia and is alert and oriented with no symptoms. What should the nurse immediately anticipate: (select all the above)
CPR
call MD
Give antidysrhythmic.
Defibrillate
give Potassium IV push
Call MD
Give antidysrhythmic.
other interventions, get code cart to the room, call Respiratory therapist, Rapid response team.
300
A nurse caring for a client who has hypertension and asks the nurse about a prescription for propranolol. The nurse should inform the client that this medication is contraindicated in clients who have a history of which of the following conditions?
- Asthma
- Glaucoma
- Depression
- Migraines
Asthma
Beta blockers are contraindicated in asthma patients because beta blockers can cause bronchospasms.
300
A nurse is preparing to administer a metformin to a client who states, "That looks different from the pill I usually take." Which of the following responses should the nurse make?
- "Describe what the pill looks like."
- "This is the medication prescribed by your provider."
- "This pill is probably from a different lot number than yours at home."
- "This hospital might use a different manufacturer, but the medication is the same."
"Describe what the pill looks like."
300
A patient is prescribed the ARB (angiotensin II receptor blocker) valsartan. The nurse is educating the patient. What statement made by the patient indicates the nurse needs to give more education?
A. I will take my blood pressure every day before I take the medication.
B. This medication may cause excess salivation which is a normal side effect of the medication.
c. This medication can cause dizziness, so I should be careful when starting this medication.
D. I need to keep taking the medication even after my blood pressure stays normal.
B is incorrect.
This medication causes dry cough and dry mucus membranes.
300
State three symptoms of left sided heart failure.
dyspnea, persistent cough, difficulty breathing while lying down, weight gain, shortness of breath with activity, fatigue, lack of appetite and nausea, rapid heartbeat.
300
A patient is being admitted to the floor with complaints of lethargy, nausea, dry skin, poor input, poor skin turgor, failure to thrive. What would the nurse expect to see when assessing urinary status?
decreased or no urine output, infrequent output, dark urine, strong smelling urine and possibly incontinence.
300
Mr. Smith is 45 and has a history of Atrial Fibrillation after having an MI five years ago. He tires easily and has been admitted with a PE (pulmonary embolism). What are three top nurse's diagnosis to be included in the plan of care?
impaired gas exchange r/t obstruction in the lung tissue
activity intolerance r/t poor perfusion
impaired perfusion r/t disruption in oxygen delivery systemically
anxiety r/t serious diagnosis for age
body image
300
name three risk factors for CHF
obesity, high fat diet, smoking, previous MI, diabetes, high blood pressure, CAD, Ethnicity, some medications, sleep disorders, viral infection to the heart muscle, alcohol, irregular heart rhythms
300
Prior to a cardiac catheterization, the nurse is educating the patient on the procedure. What statement made by the patient assures the nurse that the patient understands the pre-procedure preparation.
A. I would like privacy while I shave the area.
B. It is important to ambulate as soon as I get back to prevent pneumonia,
C. I will report any bleeding from the site after the procedure immediately.
D. I will not be able to drive until I follow up with my MD.
C. I will report any bleeding from the site after the procedure immediately.
the patient will be on anticoagulants and can hemorrhage post procedure.
300
A nurse is providing teaching to a client who takes opioid pain medication and has a new prescription for docusate sodium. Which of the following statements by the client indicates an understanding of the teaching?
- "It might take up to 3 days for the medication to work."
- "I will take the medication for diarrhea."
- "I should drink 4 ounces of water when I take the medication."
- "I can take this medication along with mineral oil."
"It might take up to 3 days for the medication to work."
400
A patient comes in diaphoretic, short of breath, nauseated. the nurse places the patient on the monitor and sees the above rhythm. What is the next intervention the nurse should anticipate?
External pacemaker until the patient receives a permanent pacemaker. The patient is in third degree heart block
400
A nurse is preparing to administer verapamil IV to a client who is having cardiac dysrhythmias. For which of the following adverse effects should the nurse monitor when giving this medication?
- Hyperthermia
- Hypotension
- Ototoxicity
- Muscle pain
Hypotension
treats high blood pressure and prevents chest pain (angina)
It may also be used to treat a fast or irregular heartbeat (arrhythmia)
400
Mr. Johnson has the following electrolyte lab results; what precaution do you expect for the patient??
Potassium 3.5 Sodium 129
Calcium 8.0 Magnesium 1.8
Seizure precautions initiated and maintained due to low sodium levels.
400
A female patient presents to the emergency department with chest pain. The nurse prepares to give her nitroglycerin o.4 Sublingual and asks her if she takes sildenafil or any other "afil" medications. Why is this important to know?
Sildenafil and a few other medications prescribed for erectile dysfunction are also given to both genders for Pulmonary Arterial Hypertension. Females can also be prescribed these medications with lower blood pressure by widening the vessels. This is contraindicated when giving Nitrates, which decrease blood pressure as well.
400
Mr. Simmons is admitted to your floor after a visit to the MD for general malaise. Labwork is complete and his BNP (B-type natriuretic peptide) is 2200, potassium is 3.0, and the Creatinine is 2.4. What does this labwork initially tell you about the patient?
The patient has elevated BNP (exacerbation CHF)
assess for low oxygen saturation, crackles in lungs, dyspnea.
The patient has low potassium and high creatinine.
assess for low urine output, impaired kidney function,
400
A patient is admitted for with a sodium level of 129. What would the nurse expect ordered for the patient.
Fluid Restriction
One time fluid bolus of 3% Normal Saline
Patient to drink 12 ounces of water hourly
send patient for dialysis STAT
Fluid Restriction
limit fluids within the vascular space due to low solute, treat underlying cause.
400
the nurse is providing education to a patient who is going home and prescribed an anticoagulant post MI. the nurse knows the patient understands instruction with what statement?
A. I cannot floss my teeth
b. I can continue to ride my rollerblades as long as I wear my helmet
C. I will call the MD for headaches or weakness
D. I can still plan to get pregnant once my coumadin is therapeutic.
C. I will call the MD for headaches or weakness
This could be a sign of intercranial bleeding and should be treated immediately.
400
Name three signs and symptoms for right sided heart failure
JVD, extreme fluid weight gain, dependant edema, fatigue, ascites, portal vein congestion, enlarged liver and spleen,
400
Ms. Green displays a positive Trousseau's sign; What does this indicate?
Hypocalcemia
400
A nurse is teaching a client who has a new prescription for codeine. Which of the following instructions should the nurse include in the teaching?
- 'You should take the medication on an empty stomach to prevent nausea."
- "You should limit alcohol intake to 12 ounces daily."
- "You should expect to experience diarrhea while taking this medication."
- "You should change positions slowly."
"You should change positions slowly."
500
A patient converts into the above rhythm and is pulseless. The healthcare team begins CPR. What is the most probable cause of this event?
Hypomagnesia can cause Torsade de Pointe.
500
A nurse is caring for a client who has heart failure and a prescription for lisinopril. Which of the following statements by the client indicates an adverse effect of the medication?
- "I can walk a mile a day."
- "I've had a backache for several days."
- "I am urinating more frequently."
- "I feel nauseated, and I have a nagging cough."
"I feel nauseated, and I have a nagging cough."
ACE inhibitor adverse reaction: dizziness, dry cough, angioedema, hyperkalemia, decrease urinary output, tiredness.
500
Give an example of a cause of hypocalcemia.
Renal failure
inadequate intake
Vitamin D deficiency
500
A nurse is teaching a client who takes warfarin daily. Which of the following statements by the client indicates a need for further teaching?
- "I will stop taking it if I get leg cramps."
- "I take this medication at the same time each day."
- "I eat a green salad every night with dinner."
- "I had my INR checked three weeks ago."
"I will stop taking it if I get leg cramps."
My indicate blood clots and will need to continue taking the medication and call the MD immediately.
500
What type of heart failure is indicated by pink, tinged frothy sputum, and positional orthopnea?
Left sided heart failure
500
Your patient had a Creatinine Kinase (blood test) result of 1500 (normal <200) and a urinalysis is positive for myoglobin. What condition do you think the patient is showing signs?
Rhabdomyolysis
500
what is the activity level of a patient who has just undergone a cardiac catheterization for reperfusion?
Bedrest, lie with head of bed flat, minimize movement of puncture site. Do not bend groin area for up to six hours after the catheter is removed.
500
Name three oxygen delivery systems
nasal cannula, simple face mask, high flow O2 , BiPap, CPap, nonrebreather, endotracheal tube (ET tube), Venturi mask.
500
Ms. Green is finishing her peritoneal dialysis cycle and complains that her abdomen is tender to touch, and the return dialysate is a tinged color. She has a low-grade fever and has 7/10 pain. the nurse suspects she is experiencing what complication?
Peritonitis.
500
A nurse is assessing a client prior to the administration of morphine. The nurse should recognize that which of the following assessments is the priority?
- Pupil reaction
- Urine output
- Bowel sounds
- Respiratory rate
Respiratory rate
600
Daily double: 
your patient is showing the following on the monitor. Upon assessing the patient, you cannot feel a pulse.
What is the rhythm? What is your intervention?
What is the nursing action?
Pulseless Electrical Activity (PEA)
Begin high quality CPR
600
A nurse is caring for a client who is prescribed warfarin therapy for an artificial heart valve. Which of the following laboratory values should the nurse monitor for a therapeutic effect of warfarin?
- Hemoglobin (Hgb)
- Prothrombin time (PT)
- Bleeding time
- Activated partial thromboplastin time (aPTT)
Prothrombin time (PT)
600
A nurse is teaching a client who has chronic kidney disease and a new prescription for epoetin alfa. The nurse should instruct the client to increase dietary intake of which of the following substances?
- Iron
- Protein
- Potassium
- Sodium
Iron
erythropoietin is the accelerator that drives erythropoiesis and iron is the fuel for the production of new red blood cells.
600
A nurse is teaching a client who has a new prescription for Atorvastatin to lower his low-density lipoprotein level. Which of the following instructions should the nurse include?
- "Do not take with grapefruit juice "
- "Reduce fluid intake."
- "Take this medication on an empty stomach."
- "Chew tablets before swallowing."
- "Do not take with grapefruit juice."
Grapefruit and grapefruit juice may interfere with the enzyme that breaks down statins and cause higher levels of statins in the blood, and may have increase chance of liver dysfunction.
600
How can you prevent Congestive Heart Failure through primary prevention?
weight control, Glucose control, healthy eating, low fat, low sugar, low carb diet, no smoking, exercise, control salt intake.
600
A nurse is assessing an older adult client who is receiving fluid resuscitation IV therapy. The nurse should recognize that which of the following findings indicates fluid volume excess? (Select all that apply.)
- Bounding pulse
- Pitting edema
- Swelling at the IV site
- Urine-specific gravity greater than 1.030
- Crackles upon auscultation
Bounding pulse
Pitting edema
Crackles upon auscultation
600
What does the pneumonic MONA-B represent when taking care of a patient experiencing chest pain.
M-Morphine
O- Oxygen
N- Nitroglycerin
A- Aspirin
B-BetaBlocker
600
Describe three types of pacemakers
Atrial
Ventricular
Atrial/Ventricular
600
The night nurse has received report from the previous nurse. Which Patient is the priority patient to assess.
A. A 71-year-old patient who is on the monitor showing Bradycardia 51 bpm who fell during the day shift.
B. A 92 year old with history of a stroke who is confused and has a sitter at the bedside.
C. A 42-year-old male who is yelling for pain medication for his day 2 post operative pain.
D. A 35-year-old patient who is admitted for pancreatitis who is complaining of nausea and vomiting.
A. A 71-year-old patient who is on the monitor showing Bradycardia 51 bpm who fell during the day shift.
Based on ABCsDEF
Airway, Breathing, Circulation, safety, Disability, Environment, Family.
600
What is the reversal medication for opioids/opiates?
naloxone (Narcan)