1118 UNIT 2 QUESTIONS WITH ACCURATE ANSWERS
Altered thought process correct answer Confusion - Thought to be because of
length of cardiac bypass, older, have significant sleep disruption, decreased
cardiac output
Orient patient, be careful of IV access (mostly for emergencies), explain
procedures, explain to family, have a clock they can see, do neuro checks, be
patient, be calm
Analgesia for MI correct answer MS IV
Give morphine 4 mg. Keep giving until pain-free
Pain increases sympathetic response (HR, BP, myocardial workload)
Angina pectoris correct answer Inadequate blood supply going to your heart
Supply and demand - Temporary and reversible. Not all patients have "classic
chest pain" use the term angina
Angina vs Myocardial Infarction correct answer Angina - There's a little room for
the blood to go through, it's just not enough
Myocardial infarction - Complete obstruction. Interrupts blood flow to one area of
the heart. That tissue dies if it isn't relieved.
Anticoagulants for MI correct answer People in Afib or with mechanical heart
valves need.
,Heparin IV - Works fast. After stopping, out of your system within hours. Started
on pt. before surgery. Reversed with protamine sulfate. After surgery, pt. started
back on coumadin and stay on heparin for another 2-5 days to allow for coumadin
to come back to full effect (INR 2-3).
Coumadin/Warfarin - Works slow. Stays with you for 1-2 weeks. Usually stopped
1-2 days before surgery and reversed with vitamin K.
Eliquis (therapeutic much more quickly. Affects 4 clotting mechanisms. No labs
usually checked) Usually given vit. k, protamine sulfate, and fresh frozen plasma
(has all clotting factors except for platelets)
Antidysrhythmics for MI correct answer Lidocaine IV
Beta-blockers IV - Esmolol can be given IV
When tissues reperfuse expect PVCs, VT. These help with that.
Assessment correct answer History
How far can they walk without SOB
Do they wake up at night with SOB
Do they have PND
How many pills do they sleep with at night?
Do they have chest pain?
Has their weight changed?
Do they have edema?
Are they concerned about their belly?
Do they wake up with a cough?
,Associated Symptoms of MI correct answer Cardiovascular - Chest pain,
tachycardia/bradycardia(usually tach), changes in BP, decreased peripheral
pulses, dysrhythmias, signs of HF, cool mottled skin, diaphoresis
Respiratory - Tachypnea, dyspnea, SOB, pulmonary congestion
Neurological - Change in level of consciousness, anxiety, feeling of impending
doom
GI - N/V because of irritation of the vagus nerve, jugular venous distention,
hepatomegaly, splenomegaly, peripheral edema
Beta Blockers correct answer Negative inotrope (weaker, slower heart beat).
Helpful for chronic angina. Blocks the stimulating effects of
norepinephrine/epinephrine. Decreases the workload of the heart. Decreases HR
and BP. Increases myocardial oxygenation.
Atenolol - Long-lasting version
Metoprolol - Short-acting version
CAD Causes/Risk factors correct answer Unknown
*Need to know risk factors*
*Non-modifiable - Age, gender, race/ethnic, heredity, personality type, premature
menopause*
*Modifiable - Nicotine (smoking) (any amount), obesity, physical inactivity,
personality type, HTN, DM, insulin resistance, hyperlipidemia*
Calcium Channel Blockers correct answer Potent coronary vasodilator
, Diltiazem Example: Bp <100, and/or HR <60 be prepared to stop or slow infusion
IV (rate control)
PO 30 mg qid or CD 120-140 mg/day
Cardiac dysrhythmias correct answer Monitor rhythm q1h (Afib, SVT,
bradycardias)
VS q4h 48 hrs OOU
Lab values: K (primary with dysrhythmias)
Medications
Cardiac Rehabilitation after MI correct answer Phase 1 (Inpatient) - ADLs are
managed. Very dependent on how pt. is doing. (Example: If HR jumps to 160
going to bathroom, use commode instead.)
Phase 2 - In the three weeks after MI. Gradually increase pt.'s activity.
Phase 3 - Transition to independence: Educate about anatomy, physiology,
outcomes. What works. How it's going to help. What medications, and why
they're taking them. Timelines of realistic expectations for accomplishments.
Everybody in the family should learn CPR
Cardiac tamponade correct answer *Medical emergency. Need to know* During
surgery, one nick on an artery or vein can cause blood to accumulate. Fluid builds
on heart, and heart can't beat.
*Narrowing pulse pressure* (dropping BP)
Bleeding can be seen on an echocardiogram
*heart sounds will be more distant* (hard to pick up on)
Chest tube output - *If fluid collects and chest tube is not working correctly, it can
compress the heart*
Altered thought process correct answer Confusion - Thought to be because of
length of cardiac bypass, older, have significant sleep disruption, decreased
cardiac output
Orient patient, be careful of IV access (mostly for emergencies), explain
procedures, explain to family, have a clock they can see, do neuro checks, be
patient, be calm
Analgesia for MI correct answer MS IV
Give morphine 4 mg. Keep giving until pain-free
Pain increases sympathetic response (HR, BP, myocardial workload)
Angina pectoris correct answer Inadequate blood supply going to your heart
Supply and demand - Temporary and reversible. Not all patients have "classic
chest pain" use the term angina
Angina vs Myocardial Infarction correct answer Angina - There's a little room for
the blood to go through, it's just not enough
Myocardial infarction - Complete obstruction. Interrupts blood flow to one area of
the heart. That tissue dies if it isn't relieved.
Anticoagulants for MI correct answer People in Afib or with mechanical heart
valves need.
,Heparin IV - Works fast. After stopping, out of your system within hours. Started
on pt. before surgery. Reversed with protamine sulfate. After surgery, pt. started
back on coumadin and stay on heparin for another 2-5 days to allow for coumadin
to come back to full effect (INR 2-3).
Coumadin/Warfarin - Works slow. Stays with you for 1-2 weeks. Usually stopped
1-2 days before surgery and reversed with vitamin K.
Eliquis (therapeutic much more quickly. Affects 4 clotting mechanisms. No labs
usually checked) Usually given vit. k, protamine sulfate, and fresh frozen plasma
(has all clotting factors except for platelets)
Antidysrhythmics for MI correct answer Lidocaine IV
Beta-blockers IV - Esmolol can be given IV
When tissues reperfuse expect PVCs, VT. These help with that.
Assessment correct answer History
How far can they walk without SOB
Do they wake up at night with SOB
Do they have PND
How many pills do they sleep with at night?
Do they have chest pain?
Has their weight changed?
Do they have edema?
Are they concerned about their belly?
Do they wake up with a cough?
,Associated Symptoms of MI correct answer Cardiovascular - Chest pain,
tachycardia/bradycardia(usually tach), changes in BP, decreased peripheral
pulses, dysrhythmias, signs of HF, cool mottled skin, diaphoresis
Respiratory - Tachypnea, dyspnea, SOB, pulmonary congestion
Neurological - Change in level of consciousness, anxiety, feeling of impending
doom
GI - N/V because of irritation of the vagus nerve, jugular venous distention,
hepatomegaly, splenomegaly, peripheral edema
Beta Blockers correct answer Negative inotrope (weaker, slower heart beat).
Helpful for chronic angina. Blocks the stimulating effects of
norepinephrine/epinephrine. Decreases the workload of the heart. Decreases HR
and BP. Increases myocardial oxygenation.
Atenolol - Long-lasting version
Metoprolol - Short-acting version
CAD Causes/Risk factors correct answer Unknown
*Need to know risk factors*
*Non-modifiable - Age, gender, race/ethnic, heredity, personality type, premature
menopause*
*Modifiable - Nicotine (smoking) (any amount), obesity, physical inactivity,
personality type, HTN, DM, insulin resistance, hyperlipidemia*
Calcium Channel Blockers correct answer Potent coronary vasodilator
, Diltiazem Example: Bp <100, and/or HR <60 be prepared to stop or slow infusion
IV (rate control)
PO 30 mg qid or CD 120-140 mg/day
Cardiac dysrhythmias correct answer Monitor rhythm q1h (Afib, SVT,
bradycardias)
VS q4h 48 hrs OOU
Lab values: K (primary with dysrhythmias)
Medications
Cardiac Rehabilitation after MI correct answer Phase 1 (Inpatient) - ADLs are
managed. Very dependent on how pt. is doing. (Example: If HR jumps to 160
going to bathroom, use commode instead.)
Phase 2 - In the three weeks after MI. Gradually increase pt.'s activity.
Phase 3 - Transition to independence: Educate about anatomy, physiology,
outcomes. What works. How it's going to help. What medications, and why
they're taking them. Timelines of realistic expectations for accomplishments.
Everybody in the family should learn CPR
Cardiac tamponade correct answer *Medical emergency. Need to know* During
surgery, one nick on an artery or vein can cause blood to accumulate. Fluid builds
on heart, and heart can't beat.
*Narrowing pulse pressure* (dropping BP)
Bleeding can be seen on an echocardiogram
*heart sounds will be more distant* (hard to pick up on)
Chest tube output - *If fluid collects and chest tube is not working correctly, it can
compress the heart*
