Diagnostic exams
Name 3 differences between Transthoracic Echocardiogram (TTE) and Transesophageal Echocardiogram (TEE)
TTE
- occurs outside the body, pt lies on side or back, abdomen and chest exposed, a gel is used and a transducer is moved around to different parts of the chest to view the heart
TEE
- occurs inside the body, empties bladder before procedure, medications are used to relax and numb the throat, transducer is guided into the mouth down the esophagus.
Name 5 signs and symptoms of atrial fibrillation
heart palpitations, anxiety, fatigue, malaise, hypotension, chest pain, diaphoresis, exercise intolerance, nausea, dyspnea, dizzines, syncope, confusion, altered LOC, pulse deficit
A patient with acute renal injury has a GFR (glomerular filtration rate) of 40 mL/min. Which signs and symptoms below may this patient present with? Select all that apply:
A. Hypervolemia
B. Hypokalemia
C. Increased BUN level
D. Decreased Creatinine level
The answers are A and C. The glomerular filtration rate indicates how well the glomerulus is filtering the blood. A normal GFR tends to be 90 mL/min or higher. A GFR of 40 mL/min indicates that the kidney’s ability to filter the blood is decreased. Therefore, the kidneys will be unable to remove waste and excessive water from the blood…hence hypervolemia and an increased BUN level will present in this patient. The patient will experience HYPERkalemia (not hypo) because the kidneys are unable to remove potassium from the blood. In addition, an INCREASED creatinine level (not decreased) will present because the kidneys cannot remove excessive waste products, such as creatinine.
Compare and contrast coup injury and contrecoup injury
Similarity: Brain tissue is damaged, but no skull fracture appears. Direct and contrecoup injury (ex. concussion or contusion).
Difference:
Coup injury: brain impacts the skull causing damage to the area impacted
Contrecoup injury: occurs in acceleration and deceleration when the brain bounces from one side of the skull the other causing damage to the contralateral side.
1. Which of the following patients are MOST at risk for developing heart failure? Select-all-that-apply:
A. A 69 year old male with a history of alcohol abuse and is recovering from a myocardial infarction.
B. A 55 year old female with a health history of asthma and hypoparathyroidism.
C. A 30 year old male with a history of endocarditis and has severe mitral stenosis.
D. A 45 year old female with lung cancer stage 2.
E. A 58 year old female with uncontrolled hypertension and is being treated for influenza.
A. A 69 year old male with a history of alcohol abuse and is recovering from a myocardial infarction.
C. A 30 year old male with a history of endocarditis and has severe mitral stenosis.
E. A 58 year old female with uncontrolled hypertension and is being treated for influenza.
Why would TEE be used over TTE, or vice versa?
- TEE is used to provide clearer images of the heart and its structures (closer to the heart via esophagus)
- TEE may be used if you have a thick chest wall, are obese, have bandages on your chest, is on a ventilator.
Which medications would you expect someone with AFIB to be on:
a. tylenol
b. clopidogrel
c. pantoprazole
d. verapamil
b. clopidogrel & d. verapamil
clopidogrel is an antiplatelet agent and verapamil is a calcium channel blocker to slow down the heart rate
______________ is solely filtered from the bloodstream via the glomerulus and is NOT reabsorbed back into the bloodstream but is excreted through the urine.
A. Urea
B. Creatinine
C. Potassium
D. Magnesium
The answer is B. Creatinine is a waste product from muscle breakdown and is removed from the bloodstream via the glomerulus of the nephron. It is the only substance that is solely filtered out of the blood but NOT reabsorbed back into the system. It is excreted out through the urine. This is why a creatinine clearance test is used as an indicator for determining renal function and for calculating the glomerular filtration rate.
A patient is admitted to the ED after sustaining abdominal injuries and a broken femur from a motor vehicle accident. The patient is pale, diaphoretic, and is not talking coherently. Vital signs upon admission are temperature of 36.3C, HR 130/min, RR 34, BP 50/40. The healthcare provider suspects which type of shock and why?
The abdominal injuries points to hypovolemic shock secondary to hemorrhage
Along with persistent, crushing chest pain, which signs/symptoms would make the nurse suspect that the client is experiencing a myocardial infarction?
1. Midepigastric pain and pyrosis
2. Diaphoresis and cool clammy skin
3. Intermittent claudication and paloor
4. Jugular vein distention and dependent edema
2. Diaphoresis is a systemic reaction to the MI. The body vasoconstricts to shunt blood from the periphery to the trunk of the body; this in turn, leads to cold, clammy skin
List the 5 diagnostic tests for liver failure and one piece of information related to them.
Liver function panel
Additional blood work
Imaging test
liver biopsy
Paracentesis
What are the surgical treatment options for heart failure?
pacemaker, LVAD, bypass surgery, percutaneous coronary intervention
Which condition is NOT a known cause of cirrhosis?*
A. Obesity
B. Alcohol consumption
C. Blockage of the bile duct
D. Hepatitis C
E. All are known causes of cirrhosis
E. all of them can cause cirrhosis
A nurse reviews the arterial blood gas results of a client and notes the following: pH 7.45, Pco2 of 30, and HCO3- of 22. The nurse analyzes these results as indicating which condition?
1) Metabolic Acidosis, compensated
2) Respiratory Alkalosis, compensated
3) Metabolic Alkalosis, compensated
4) Respiratory Acidosis, compensated
Answer: 2
Rational: The normal pH is 7.3-7.45. In a respiratory condition, an opposite effect will be seen between the pH and the Pco2. In this condition, the pH is a the high end of normal and the Pco2 is low. In an alkalotic condition, the pH is elevated. Therefore the values identified in the question indicated a respiratory alkalosis. When the pH returns to a normal value, compensation has occurred.
The nurse is administering a calcium channel blocker to the client diagnosed with a myocardial infarction. Which assessment data would cause the nurse to question administering this medication?
1. The client's apical pulse is 64
2. The client's calcium level is elevated
3. The client's telemetry shows occasional PVCs
4. The client's blood pressure is 90/62
4. The client's blood pressure is low, and a calcium channel blocker could cause the blood pressure to bottom out.
List the post care of TTE vs TEE
post care for TTE: may resume usual diet and activities
Post care for TEE: pt will not be able to swallow properly for 2 hours post procedure; avoid eating salad; do not drink alcohol, sleeping medications, or anti-anxiety medications for at least 24 hr as it may interfere with sedatives given; pt cannot drive for at least 18-24 hr post procedure
The nurse is administering a calcium channel blocker to the client diagnosed with a myocardial infarction. Which assessment data would cause the nurse to question administering this medication?
1. The client's apical pulse is 64
2. The client's calcium level is elevated
3. The client's telemetry shows occasional PVCs
4. The client's blood pressure is 90/62
4. The client's blood pressure is low, and a calcium channel blocker could cause the blood pressure to bottom out.
A patient with late-stage cirrhosis develops portal hypertension. Which of the following options below are complications that can develop from this condition? Select all that apply:
A. Increase albumin levels
B. Ascites
C. Splenomegaly
D. Fluid volume deficient
E. Esophageal varices
The answer are B, C, and E. Portal Hypertension is where the portal vein becomes narrow due to scar tissue in the liver, which is restricting the flow of blood to the liver. Therefore, pressure becomes increased in the portal vein and affects the organs connected via the vein to the liver. The patient may experience ascites, enlarged spleen “splenomegaly”, and esophageal varices etc.
A client has been in the ICU for 6 weeks for treatment of a traumatic head injury. Brain death has just been declared. Which assessment findings would the nurse anticipate? Select all that apply.
a. Normal temperature
b. Presence of coma
c. Apnea
d. Loss of brainstem reflexes
e. Constricted pupils
(a)Normal temperature, (b) Presence of coma, (c) Apnea, (d)Loss of brainstem reflexes,
Loss of brainstem reflexes is a criterion for declaring brain death.
Pupils will be fixed and dilated.
Presence of coma is a criterion for declaring brain death.
Apnea is a criterion for declaring brain death.
A 74 year old female presents to the ER with complaints of dyspnea, persistent cough, and unable to sleep at night due to difficulty breathing. On assessment, you note crackles throughout the lung fields, respiratory rate of 25, and an oxygen saturation of 90% on room air. Which of the following lab results confirm your suspicions of heart failure?
A. K+ 5.6
B. BNP 820
C. BUN 9
D. Troponin <0.02
B. BNP 820
BNP is a hormone produced by your heart. levels go up when heart failure develops or worsens
What is the purpose of doing paracentesis in liver failure
Ascites is common in those with cirrhosis. Paracentesis may be performed to drain the fluid and be examined for signs of infection, cancer, and to determine cause for fluid accumulation.
The client is admitted to the emergency department, and the nurse suspects a cardiac problem. Which assessment interventions should the nurse implement? Select All that Apply
1. Obtain a midstream urine specimen
2. Attach telemetry monitor to the client
3. Start a saline lock in the right arm
4. Draw a baseline metabolic panel (BMP)
5. Request an order for a STAT 12-lead ECG
2. Anytime a nurse suspects cardiac problems, the electrical conductivity of the heart should be assessed.
3. Emergency medications for heart problems are primarily administered intravenously, so starting a saline lock in the right arm is appropriate.
5. A 12-lead ECG evaluates the electrical conductivity of the heart from all planes.
A 68-year-old patient who is hospitalized with pneumonia is disoriented and confused 3 days after admission. Which information indicates that the patient is experiencing delirium rather than dementia?
a. The patient was oriented and alert when admitted.
b. The patient's speech is fragmented and incoherent.
c. The patient is oriented to person but disoriented to place and time.
d. The patient has a history of increasing confusion over several years.
ANS: A-The patient was oriented and alert when admitted
The onset of delirium occurs acutely. The degree of disorientation does not differentiate between delirium and dementia. Increasing confusion for several years is consistent with dementia. Fragmented and incoherent speech may occur with either delirium or dementia.
Your patient in neurogenic shock is not responding to IV fluids. The patient is started on vasopressors. What option below, if found in your patient, would indicate the medication is working?
A) Decreased CVP (central venous pressure)
B) Mean arterial pressure (MAP) 90 mmHg
C) Serum lactate 6 mmol/L
D) Blood pH 7.20
B) MAP of 90 mm Hg
Rationale:
A MAP of 85-90 mmHg will help maintain tissue perfusion and indicates the vasopressor is working to maintain tissue perfusion. It does this by causing vasoconstriction. Options A, C, and D would indicate tissue perfusion is decreased.
The client comes into the emergency department saying, "I am having a heart attack" Which question is most pertinent when assessing the client?
1. "Can you describe the chest pain"
2. "What were you doing when the pain started"
3. "Did you have a high-fat meal today"
4. "Does the pain get worse when you lie down"
1. The chest pain for MI is usually described as an elephant sitting on the chest or a belt squeezing the substernal midchest, often radiating to the jaw or left arm.