Carl Shapiro (coronary artery disease) Questions and Answers 2023 Graded A+

When a patient is experiencing angina, the nurse administers nitroglycerin sublingually at what frequency? - every 5 minutes, maximum 3 doses When a pt is experiencing acute angina, it's recommended that the pt allow 1 sublingual tablet to dissolve under the tongue (or spray nitroglycerin under the tongue) and repeat every 5 min for maximum of 3 doses When administering medication to pt w/ suspected MI, the nurse understands that morphine has which of the following beneficial effects? - decreases anxiety decreases pain decreases preload decreases afterload Morphine is drug of choice to reduce pain, thereby reducing anxiety. it also reduces preload and afterload, decreasing work of heart. pt must be monitored closely for SEs of hypotension and respiratory depression Which of the following are cardiac markers assessed in the pt experiencing angina potential myocardial injury? - troponin CK-MB cardiac enzymes and biomarkers, which include troponin, CK, and myoglobin, are used to diagnose an acute MI. of the 3 CK isoenzymes, CK-myocardial bound (MB) is specific to heart muscle. CK-MM is specific to skeletal muscle and is not an indicator of MI. hemoglobin is used to determine amount of O2 in the blood. creatinine is elevated in renal failure, not in myocardial injury. the nurse recognizes that ST elevation on the 12-lead ECG typically indicates which of the following? - myocardial injury (causes ST segment and T-wave changes on ECG) the nurse knows that which factors may increase pt's risk of developing coronary artery disease? - cigarette smoking metabolic syndrome family history non-modifiable risk factors for CAD include family hx and increasing age ( 55 y/o for women). cigarette smoking and metabolic syndrome are modifiable risk factors for CAD. a diagnosis of metabolic syndrome includes 3 of following: insulin resistance, central obesity, dyslipidemia, BP persistently 130/85, high levels of C-reactive proteins, and high fibrinogen level. Any activity based on pt's capability is encouraged. which of the following does the nurse recognize as typical s/s exhibited by pt with angina? - substernal chest pain SOB diaphoresis substernal chest pain or heaviness that may radiate, SOB, dusky or pallor skin, diaphoresis, weakness, n/v, and denial by patient the nurse understands that aspirin is administered to a pt with suspected MI for which of the following reasons? - to prevent platelet aggregation pt with suspected MI should receive aspirin immediately, unless allergic to it, to help prevent plt aggregation V fib: - is characterized by a ventricular rate 300 bpm, an extremely irregular rhythm w/o specific pattern, and irregular, undulating waves w/o recognizable QRS complexes The nurse recalls that, according to the AHA guidelines for adult CPR, the correct compression: ventilation ratio and rate per minute is which of the following? - 30:2, at least 100/min Is the following statement true or false? According to American Heart Association guidelines, epinephrine 1 mg administered for ventricular fibrillation after the second defibrillation - true as per guideline, epi can be given every 3-5 minutes. The first dose of epi is administered after the second defib When a pt is to receive defibrillation, the nurse ensures that which of the following safety measures are implemented? - Clearing bed at least twice prior to defibrillating not touching bed or allowing any objects to touch bed removing O2 from bed during defibrillation To prevent injury to staff! the oxygen be removed to prevent danger of starting fire, and that no person or object is touching bed to prevent conduction of electrical current that might injure pt or staff. Compression and ventilations would be interrupted during defib if peripheral IV access cannot be established during cardiac arrest after several attempts by the nurse, the nurse would next consider which access for rapid delivery of medications? - intraosseous (IO) access ideally 2 large-bore peripheral IV lines are established during a code for fluid and medication administration. Alternately, IO access may be established and can be inserted w/o interrupting CPR. If IV or IO can't be established, meds such as epi and vasopressin can be given through ET tube during cardiac arrest. A central line takes more time to place. When viewing the past medical hx, the nurse identifies which cardiac risk factor specific to Carl Shapiro? - HTN cigarette smoking obesity non-modifiable cardiac risk factors: family hx, increasing age, gender, and race. modifiable cardiac risk factors can include hyperlipidemia, tobacco, HTN, diabetes, metabolic syndrome, obesity, and physical inactivity. Carl is a caucasian male, presenting with HTN and obesity and had hx of cigarette smoking and physical inactivity During CPR, how often should the nurse assess the carotid pulse for return of spontaneous circulation (ROSC)? - 2 min the carotid pulse should be assessed every 2 min. for return of spontaneous circulation T/F: if carl shapiro had proceeded into asystole after v fib, continuing to defibrillate would have been the appropriate intervention. - False What is the next drug after epi that the nurse should expect to administer to pt in v fib? - Amiodarone as per AHA guidelines, the meds to give to the pt after continuing CPR and administering the epi is amiodarone 300mg w/ a second dose of amiodarone 150mg if needed during v fib, pitressin (vasopressin) may be used in place of epi for the first or second dose. If administering Vasopressin, what dosage would he nurse expect to administer? - 40 units IV/IO Pitressin (Vasopressin) 40 unites IV/IO can be used to replace either the first or second dose of epinephrine when the nurse discovers a pt is not visibly breathing, the nurse knows that which of the following is immediate priority? - Assessing carotid pulse If there is no pulse, then the nurse needs to start compression immediately while initiating a cod